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Lukac S, Hancke K, Janni W, Pfister K, Schäffler H, Schmid M, Ebner F, Kloss T, Dayan D. Three-dimensional model for improvement of endometriosis care (3D-E). Int J Gynaecol Obstet 2024; 165:416-423. [PMID: 37795648 DOI: 10.1002/ijgo.15165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 09/10/2023] [Accepted: 09/16/2023] [Indexed: 10/06/2023]
Abstract
OBJECTIVE Endometriosis affects approximately 10% of women of reproductive age and leads to significant morbidity and financial burden. Consequently, countries such as France and Germany are formulating strategies to combat endometriosis. In this study, we propose the implementation of our three-dimensional model (3D-E) to raise awareness about endometriosis and enhance timely diagnosis, treatment, and long-term care for affected patients. METHODS Based on the adapted Six Sigma Principle and the modified recommendation of Sales et al. for implementing evidence-based findings into a clinical routine, we first conducted a comprehensive investigation to identify risk factors leading to diagnostic delay of endometriosis. After identifying improvable factors, the applicable options were selected due to defined criteria such as integrability in the clinical routine, cost-effectiveness, and evidence-based-principle. Finally, solutions feasible for health care providers were integrated and the 3D-E model was established. RESULTS Some of the main risk factors contributing to diagnostic delays are symptoms acceptance and misinterpreted symptoms, especially if presenting to nongynecologists in cases of extragenital endometriosis with atypical presentation. Therefore, we tried to sensitize colleagues (first dimension) with a review paper in Germany's largest medical journal and started an elective for medical students (second dimension) at our university. In order to involve additional health care professionals in endometriosis care (third dimension), we are preparing the concept of the EndoNurse. CONCLUSION The 3D-E model is a relatively low-cost, comprehensive, and worldwide adaptable approach for facilitating knowledge transfer, sensitizing health care providers, and improving endometriosis diagnostics and therapy for patients with endometriosis who are in the center of the model.
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Affiliation(s)
- Stefan Lukac
- Department of Obstetrics and Gynecology, University Hospital Ulm, Ulm, Germany
| | - Katharina Hancke
- Department of Obstetrics and Gynecology, University Hospital Ulm, Ulm, Germany
| | - Wolfgang Janni
- Department of Obstetrics and Gynecology, University Hospital Ulm, Ulm, Germany
| | - Kerstin Pfister
- Department of Obstetrics and Gynecology, University Hospital Ulm, Ulm, Germany
| | - Henning Schäffler
- Department of Obstetrics and Gynecology, University Hospital Ulm, Ulm, Germany
| | - Marinus Schmid
- Department of Obstetrics and Gynecology, University Hospital Ulm, Ulm, Germany
| | - Florian Ebner
- Department of Obstetrics and Gynecology, University Hospital Ulm, Ulm, Germany
- Gynäkologische Gemeinschaftspraxis Freising & Moosburg, Munich, Germany
| | - Tabea Kloss
- Department of Obstetrics and Gynecology, University Hospital Ulm, Ulm, Germany
| | - Davut Dayan
- Department of Obstetrics and Gynecology, University Hospital Ulm, Ulm, Germany
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Yoshikawa H, Uehara T, Yamashita S, Ikusaka M. X-ray-negative Occult Foot Bone Fracture Mimicking Cellulitis. Intern Med 2024; 63:1183. [PMID: 37690848 DOI: 10.2169/internalmedicine.1864-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/12/2023] Open
Affiliation(s)
| | - Takanori Uehara
- Department of General Medicine, Chiba University Hospital, Japan
| | - Shiho Yamashita
- Department of General Medicine, Chiba University Hospital, Japan
| | - Masatomi Ikusaka
- Department of General Medicine, Chiba University Hospital, Japan
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McDermott GC, Monshizadeh A, Selzer F, Zhao SS, Ermann J, Katz JN. Factors Associated With Diagnostic Delay in Axial Spondyloarthritis: Impact of Clinical Factors and Social Vulnerability. Arthritis Care Res (Hoboken) 2024; 76:541-549. [PMID: 37881826 PMCID: PMC10963166 DOI: 10.1002/acr.25264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 08/23/2023] [Accepted: 10/23/2023] [Indexed: 10/27/2023]
Abstract
OBJECTIVE Patients with axial spondyloarthritis (axSpA) often experience significant delay between symptom onset and diagnosis for reasons that are incompletely understood. We investigated associations between demographic, medical, and socioeconomic factors and axSpA diagnostic delay. METHODS We identified patients meeting modified New York criteria for ankylosing spondylitis (AS) or 2009 Assessment of Spondyloarthritis International Society criteria for axSpA in the Mass General Brigham health care system between December 1990 and October 2021. We determined the duration of diagnostic delay, defined as the duration of back pain symptoms reported at diagnosis, as well as disease manifestations and specialty care prior to diagnosis from the electronic health record. We obtained each patient's Social Vulnerability Index (SVI) by mapping their address to the US Centers for Disease Control SVI Atlas. We examined associations among disease manifestations, SVI, and diagnostic delay using ordinal logistic regression. RESULTS Among 554 patients with axSpA who had a median diagnostic delay of 3.8 years (interquartile range 1.1-10), peripheral arthritis (odds ratio [OR] 0.65, 95% confidence interval [CI] 0.45-0.93) and older age at symptom onset (OR 0.83, 95% CI 0.78-0.88 per five years) were associated with shorter delay. AS at diagnosis (OR 1.85, 95% CI 1.30-2.63), a history of uveitis prior to diagnosis (OR 2.77, 95% CI 1.73-4.52), and higher social vulnerability (defined as national SVI 80th to 99th percentiles; OR 1.99, 95% CI 1.06-3.84) were associated with longer diagnostic delay. CONCLUSION Older age at back pain onset and peripheral arthritis were associated with shorter delay, whereas uveitis was associated with longer diagnostic delay. Patients with higher socioeconomic vulnerability had longer diagnostic delay independent of clinical factors.
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Affiliation(s)
- Gregory C McDermott
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | | | - Faith Selzer
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | | | - Joerg Ermann
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Jeffrey N Katz
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
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Hadjinicolaou A, Briscoe Abath C, Singh A, Donatelli S, Salussolia CL, Cohen AL, He J, Gupta N, Merchant S, Zhang B, Olson H, Yuskaitis CJ, Libenson MH, Harini C. Timing the clinical onset of epileptic spasms in infantile epileptic spasms syndrome: A tertiary health center's experience. Epilepsia 2024; 65:984-994. [PMID: 38317356 PMCID: PMC11018499 DOI: 10.1111/epi.17900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 01/12/2024] [Accepted: 01/16/2024] [Indexed: 02/07/2024]
Abstract
OBJECTIVE Lead time to treatment (clinical onset of epileptic spasms [ES] to initiation of appropriate treatment) is known to predict outcomes in infantile epileptic spasms syndrome (IESS). Timing the clinical onset of ES is crucial to establish lead time. We investigated how often ES onset could be established to the nearest week. We aimed to (1) ascertain the exact date or estimate the nearest week of ES onset and (2) compare clinical/demographic factors between patients where date of ES onset was determined or estimated to the nearest week and patients whose date of ES onset could not be estimated to the nearest week. Reasons for difficulties in estimating date of ES onset were explored. METHODS Retrospective chart review of new onset IESS patients (January 2019-May 2022) extracted the date or week of the clinical onset of ES. Predictors of difficulty in date of ES onset estimation to the nearest week were examined by regression analysis. Sources contributing to difficulties determining date of ES onset were assessed after grouping into categories (provider-, caregiver-, disease-related). RESULTS Among 100 patients, date of ES onset was estimated to the nearest week in 47%. On univariable analysis, age at diagnosis (p = .021), development delay (p = .007), developmental regression/stagnation (p = .021), ES intermixed with other seizures (p = .011), and nonclustered ES at onset (p = .005) were associated with difficulties estimating date of ES onset. On multivariable analysis, failure to establish date of ES onset was related to ES intermixed with other seizures (p = .004) and nonclustered ES at onset (p = .003). Sources contributing to difficulties determining date of ES onset included disease-related factors (ES characteristics, challenges interpreting electroencephalograms) and provider/caregiver-related factors (delayed diagnosis). SIGNIFICANCE Difficulties with estimation of lead time (due to difficulties timing ES onset) can impact clinical care (prognostication), as even small increments in lead time duration can have adverse developmental consequences.
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Affiliation(s)
- Aristides Hadjinicolaou
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Christina Briscoe Abath
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Avantika Singh
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Stephanie Donatelli
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Catherine L Salussolia
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Alexander Li Cohen
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jie He
- Biostatistics and Research Design Center, Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Nishtha Gupta
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Sabrina Merchant
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Bo Zhang
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Biostatistics and Research Design Center, Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Heather Olson
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Christopher J Yuskaitis
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Mark H Libenson
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Chellamani Harini
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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El-Hajj VG, Daller C, Fletcher-Sandersjöö A, Gharios M, Bydon M, Söderman M, Jabbour P, Edström E, Elmi-Terander A, Arnberg F. The negative impact of treatment delays on the long-term neurological outcomes of spinal dural arteriovenous fistulas: a longitudinal cohort study. Neurosurg Focus 2024; 56:E14. [PMID: 38427990 DOI: 10.3171/2023.12.focus23703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 12/27/2023] [Indexed: 03/03/2024]
Abstract
OBJECTIVE Dural arteriovenous fistulas are rare vascular malformations that affect the brain and spinal cord. Spinal dural arteriovenous fistulas (sdAVFs) are the most frequently encountered vascular malformation affecting the spinal cord. The object of this study was to evaluate the impact of treatment delays on the long-term neurological outcomes of either open surgical or interventional treatment of sdAVFs. METHODS In this retrospective, population-based cohort study, the authors examined consecutive patients with diagnosed sdAVFs at a tertiary care center between 2005 and 2020. Patients were assessed using the Aminoff-Logue disability scale (ALS) at various time points including symptom onset, primary care visit, first specialist outpatient visit, as well as both short and long-term follow-ups. The postoperative long-term ALS gait and bladder grades constituted the primary outcomes of the study. RESULTS Among the 34 patients included in the study, the median age was 65 years, and there was a male predominance (71%). Most lesions were in the lumbar region (47%). Significant worsening in ALS gait and bladder grades was observed preoperatively, followed by postoperative improvements (p < 0.05). There was no difference in outcomes between surgical and endovascular treatments. Older age (OR 1.10, 95% CI 1.03-1.17, p = 0.007), worse preoperative ALS gait grades (OR 5.12, 95% CI 2.18-12.4, p < 0.001), and longer time from first specialist outpatient visit to first treatment (OR 1.00, 95% CI 1.00-1.01, p = 0.040) were independently associated with worse long-term gait outcomes. Only the preoperative ALS bladder score was a predictor of worse long-term bladder function (OR 92.7, 95% CI 28.0-306.7, p < 0.001). CONCLUSIONS Both surgical and endovascular treatments for sdAVFs led to significant neurological improvements. However, treatment delays were associated with less favorable long-term outcomes. Prompt diagnosis and early intervention prior to symptom progression may enhance recovery and help to preserve neurological function.
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Affiliation(s)
| | - Cornelia Daller
- 1Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- 2Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
- 8Department of Neurosurgery, University Hospital Salzburg, Paracelsus Medical University Salzburg, Austria; and
- 9Department of Neurosurgery, University Hospital St. Pölten, Karl-Landsteiner University of Health Sciences, St. Pölten, Austria
| | | | - Maria Gharios
- 1Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Mohamad Bydon
- 3Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota
| | - Michael Söderman
- 1Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- 2Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | - Pascal Jabbour
- 4Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Erik Edström
- 1Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- 5Capio Spine Center Stockholm, Löwenströmska Hospital, Stockholm, Sweden
- 6Department of Medical Sciences, Örebro University, Örebro, Sweden
| | - Adrian Elmi-Terander
- 1Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- 5Capio Spine Center Stockholm, Löwenströmska Hospital, Stockholm, Sweden
- 6Department of Medical Sciences, Örebro University, Örebro, Sweden
- 7Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Fabian Arnberg
- 1Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- 2Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
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van Oorschot HD, de Jel DVC, Hardillo JA, Smeele LE, Baatenburg de Jong RJ. National Improvement of Waiting Times: First Results From the Dutch Head and Neck Audit. Otolaryngol Head Neck Surg 2024; 170:766-775. [PMID: 37747035 DOI: 10.1002/ohn.532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 08/21/2023] [Accepted: 09/05/2023] [Indexed: 09/26/2023]
Abstract
OBJECTIVE Timely treatment initiation in head and neck cancer (HNC) care is of great importance regarding survival, oncological, functional, and psychological outcomes. Therefore, waiting times are assessed in the Dutch Head and Neck Audit (DHNA). This audit aims to assess and improve the quality of care through feedback and benchmarking. For this study, we examined how waiting times evolved since the start of the DHNA. STUDY DESIGN Prospective cohort study. SETTING National multicentre study. METHODS The DHNA was established in 2014 and reached national coverage of all patients treated for primary HNC in 2019. DHNA data on curative patients from 2015 to 2021 was extracted on national (benchmark) and hospital level. We determined 3 measures for waiting time: (1) the care pathway interval (CPI, first visit to start treatment), (2) the time to treatment interval (TTI, biopsy to start treatment), and (3) CPI-/TTI-indicators (percentage of patients starting treatment ≤30 days). The Dutch national quality norm for the CPI-indicator is 80%. RESULTS The benchmark median CPI and TTI improved between 2015 and 2021 from 37 to 26 days and 37 to 33 days, respectively. Correspondingly, the CPI- and TTI-indicators, respectively, increased from 39% to 64% and 35% to 40% in 2015 to 2021. Outcomes for all hospitals improved and dispersion between hospitals declined. Four hospitals exceeded the 80% quality norm in 2021. CONCLUSION Waiting times improved gradually over time, with 4 hospitals exceeding the quality standard in 2021. On the hospital-level, process improvement plans have been initiated. Systematic registration, auditing, and feedback of data support the improvement of quality of care.
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Affiliation(s)
- Hanneke Doremiek van Oorschot
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus Medical Centre Cancer Institute, Rotterdam, The Netherlands
| | | | - Jose Angelito Hardillo
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus Medical Centre Cancer Institute, Rotterdam, The Netherlands
| | - Ludi E Smeele
- Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute/Antoni van Leeuwenhoek, Amsterdam, Netherlands
| | - Robert Jan Baatenburg de Jong
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus Medical Centre Cancer Institute, Rotterdam, The Netherlands
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Conigliaro P, D’Antonio A, Wlderk A, Sabuzi F, Ferraioli M, Sichi L, Da Ros V, Biancone L, Bergamini A, Sole Chimenti M. Clinical and imaging findings in enteropathic spondyloarthritis with special emphasize in diagnostic delay: a cross-sectional study. Ther Adv Chronic Dis 2024; 15:20406223241229843. [PMID: 38380226 PMCID: PMC10878219 DOI: 10.1177/20406223241229843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 01/10/2024] [Indexed: 02/22/2024] Open
Abstract
Background Enteropathic spondyloarthritides (eSpAs) are chronic inflammatory joint diseases associated with inflammatory bowel disease (IBD). Limited data are available on the prevalence since arthritis in IBD patients may be underestimated because medications may hide disease activity with a possible diagnostic delay. Objectives We aimed to evaluate diagnostic delay in eSpA and explore associated demographic, clinical, and radiographic characteristics. Design Single-centre cross-sectional study conducted on consecutive out-patients referred to the combined Gi-Rhe clinic (November 2018-October 2019). Methods We analysed eSpA patients for diagnostic delay, disease activity, inflammatory markers, conventional radiography (CR) and magnetic resonance images (MRI) of sacroiliac joints/spine. Results A total of 190 eSpA patients [118 peripheral SpA, 72 axial (Ax) SpA including 44 non-radiographic (nr)-axSpA] were enrolled. axSpA patients had a higher prevalence of men sex, HLA-B27 positivity, uveitis and pancolitis compared with peripheral eSpA. Median diagnostic delay in eSpA was 48 months (IQR 6-77) with no difference between axial and peripheral patients. Radiographic-axial SpA (r-axSpA) patients displayed a higher diagnostic delay compared with nr-axSpA (median/IQR 36/17-129 versus 31/10-57 months, p = 0.03) and were older, with longer disease duration, low education status and high rate of employment than patients with nr-axSpA. r-axSpA patients with sclerosis, syndesmophytes and bridge at CR had higher diagnostic delay than those without lesions. Men showed higher prevalence of spine damage lesions than women as sclerosis, squaring, syndesmophytes and bridges. Longer disease duration was detected in patients with radiographic damage as bridge and sacroiliitis grade 3. On MRI, sacroiliac bone oedema was associated with reduced diagnostic delay, whereas bone erosions were associated with higher diagnostic delay compared with that in patients without these lesions. Patients with psoriasis displayed a higher diagnostic delay compared to those without skin involvement. Conclusion Diagnostic delay was higher in r-axSpA compared with nr-axSpA despite the same treatment. Demographic, clinical features and radiological lesions were associated with diagnostic delay.
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Affiliation(s)
- Paola Conigliaro
- Rheumatology, Allergology and Clinical Immunology, Department of “Medicina dei Sistemi”, University of Rome Tor Vergata, Via Montpellier 1, Rome 00133, Italy
| | - Arianna D’Antonio
- Rheumatology, Allergology and Clinical Immunology, Department of “Medicina dei Sistemi”, University of Rome Tor Vergata, Rome, Italy
| | - Andrea Wlderk
- Department of Diagnostic, UOC of Diagnostic and Interventional Neuroradiology, San Camillo-Forlanini Hospital, Rome, Italy
| | - Federico Sabuzi
- Department of Diagnostic Imaging and Interventional Radiology, University of Rome Tor Vergata, Rome, Italy
| | - Mario Ferraioli
- Rheumatology, Allergology and Clinical Immunology, Department of “Medicina dei Sistemi”, University of Rome Tor Vergata, Rome, Italy
| | - Leonardo Sichi
- Rheumatology Unit, Azienda Ospedaliero-Universitaria di Cagliari, Cagliari, Italy
| | - Valerio Da Ros
- Department of Diagnostic Imaging and Interventional Radiology, University of Rome Tor Vergata, Rome, Italy
| | - Livia Biancone
- Gastroenterology Unit, Department of “Medicina dei Sistemi”, University of Rome Tor Vergata, Rome, Italy
| | - Alberto Bergamini
- Rheumatology, Allergology and Clinical Immunology, Department of “Medicina dei Sistemi”, University of Rome Tor Vergata, Rome, Italy
| | - Maria Sole Chimenti
- Rheumatology, Allergology and Clinical Immunology, Department of “Medicina dei Sistemi”, University of Rome Tor Vergata, Rome, Italy
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8
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Chen S, Carter D, Brockenbrough PB, Cox S, Gwathmey K. Racial disparities in ALS diagnostic delay: a single center's experience and review of potential contributing factors. Amyotroph Lateral Scler Frontotemporal Degener 2024; 25:112-118. [PMID: 37909302 DOI: 10.1080/21678421.2023.2273361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 10/10/2023] [Indexed: 11/03/2023]
Abstract
OBJECTIVE Outcomes for amyotrophic lateral sclerosis (ALS) patients are improved with prompt diagnosis, earlier initiation of disease-modifying treatments, and participation in a multidisciplinary clinic. We studied diagnostic delay and disease severity at time of clinic presentation between Black and non-Hispanic Caucasian ALS patients. METHODS We performed a retrospective analysis of non-Hispanic Caucasian and Black ALS patients seen in the Virginia Commonwealth University Health System multidisciplinary ALS clinic between 2017 and 2023. Diagnostic delay, ALS Functional Rating Scale-Revised (ALSFRS-R) and upright forced vital capacity (FVC) scores at baseline appointment were collected. Patient's distance from clinic and affluency of residential neighborhood were evaluated. RESULTS We analyzed 172 non-Hispanic Caucasian and 33 Black ALS patients. Black patients had a 64% increase in diagnostic delay compared to non-Hispanic Caucasian patients. Black patients had a lower performance on ALSFRS-R (5.3 points, p < 0.001) and FVC (17.9 percentage points p < 0.001) at time of first clinic visit. Black patients lived closer to clinic, with higher proportion living in the city of Richmond, but in less affluent areas with lower median house income ($55,300 ± 22,600 vs $69,900 ± 23,700). DISCUSSION Our findings demonstrate a large racial difference in ALS diagnostic delay, and greater disease severity and lower respiratory function at time of diagnosis for Black ALS patients. Delay in diagnosis prolongs access to disease-modifying therapies, multidisciplinary care, durable medical equipment, and respiratory and nutritional support. Potential sources of these racial disparities include providers' implicit bias and structural racism.
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Affiliation(s)
- Shanshan Chen
- Department of Biostatistics, Virginia Commonwealth University, Richmond, VA, USA
| | - Demetrius Carter
- Department of Neurology, Virginia Commonwealth University, Richmond, VA, USA
| | | | - Stephen Cox
- Department of Neurology, University of Colorado, Aurora, CO, USA
| | - Kelly Gwathmey
- Department of Neurology, Virginia Commonwealth University, Richmond, VA, USA
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9
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Knott R, Mellahn OJ, Tiego J, Kallady K, Brown LE, Coghill D, Williams K, Bellgrove MA, Johnson BP. Age at diagnosis and diagnostic delay across attention-deficit hyperactivity and autism spectrums. Aust N Z J Psychiatry 2024; 58:142-151. [PMID: 37885260 PMCID: PMC10838471 DOI: 10.1177/00048674231206997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
BACKGROUND Despite the known benefits of accurate and timely diagnosis for children with attention-deficit hyperactivity disorder and autism spectrum disorders (autism), for some children this goal is not always achieved. Existing research has explored diagnostic delay for autism and attention-deficit hyperactivity disorder only, and when attention-deficit hyperactivity disorder and autism co-occur, autism has been the focus. No study has directly compared age at diagnosis and diagnostic delay for males and females across attention-deficit hyperactivity disorder, autism and specifically, attention-deficit hyperactivity disorder + autism. METHODS Australian caregivers (N = 677) of children with attention-deficit hyperactivity disorder, autism or attention-deficit hyperactivity disorder + autism were recruited via social media (n = 594) and the Monash Autism and ADHD Genetics and Neurodevelopment Project (n = 83). Caregivers reported on their child's diagnostic process. Diagnostic delay was the mean difference between general initial developmental concerns and the child's attention-deficit hyperactivity disorder and autism diagnosis. RESULTS Children with autism were significantly younger at autism diagnosis than the attention-deficit hyperactivity disorder + autism group (ηp2 = 0.06), whereas children with attention-deficit hyperactivity disorder were significantly older at attention-deficit hyperactivity disorder diagnosis than the attention-deficit hyperactivity disorder + autism group (ηp2 = 0.01). Delay to attention-deficit hyperactivity disorder and autism diagnosis was significantly longer in the attention-deficit hyperactivity disorder + autism group compared to attention-deficit hyperactivity disorder (ηp2 = 0.02) and autism (η2 = 0.04) only. Delay to autism diagnosis for females with autism (η2 = 0.06) and attention-deficit hyperactivity disorder + autism (η2 = 0.04) was longer compared to males. CONCLUSIONS Having attention-deficit hyperactivity disorder + autism and being female were associated with longer delays to diagnosis. The reasons for these delays and possible adverse effects on outcomes require further study.
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Affiliation(s)
- Rachael Knott
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, VIC, Australia
| | - Olivia J Mellahn
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, VIC, Australia
| | - Jeggan Tiego
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, VIC, Australia
| | - Kathryn Kallady
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, VIC, Australia
| | - Louise E Brown
- School of Nursing, Midwifery and Paramedicine, Curtin University, Bentley, WA, Australia
| | - David Coghill
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, VIC, Australia
- Department of Mental Health, The Royal Children's Hospital, Parkville, VIC, Australia
- Neurodevelopment and Disability Research, Murdoch Children's Research Institute, The Royal Children's Hospital, Parkville, VIC, Australia
| | - Katrina Williams
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, VIC, Australia
- Neurodevelopment and Disability Research, Murdoch Children's Research Institute, The Royal Children's Hospital, Parkville, VIC, Australia
- Department of Developmental Paediatrics, Monash Children's Hospital, Clayton, VIC, Australia
- Department of Paediatrics, Monash University, Monash Children's Hospital, Clayton, VIC, Australia
| | - Mark A Bellgrove
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, VIC, Australia
| | - Beth P Johnson
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, VIC, Australia
- Department of Paediatrics, Monash University, Monash Children's Hospital, Clayton, VIC, Australia
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10
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Kang MJY, Eratne D, Dobson H, Malpas CB, Keem M, Lewis C, Grewal J, Tsoukra V, Dang C, Mocellin R, Kalincik T, Santillo AF, Zetterberg H, Blennow K, Stehmann C, Varghese S, Li QX, Masters CL, Collins S, Berkovic SF, Evans A, Kelso W, Farrand S, Loi SM, Walterfang M, Velakoulis D. Cerebrospinal fluid neurofilament light predicts longitudinal diagnostic change in patients with psychiatric and neurodegenerative disorders. Acta Neuropsychiatr 2024; 36:17-28. [PMID: 37114460 DOI: 10.1017/neu.2023.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
OBJECTIVE People with neuropsychiatric symptoms often experience delay in accurate diagnosis. Although cerebrospinal fluid neurofilament light (CSF NfL) shows promise in distinguishing neurodegenerative disorders (ND) from psychiatric disorders (PSY), its accuracy in a diagnostically challenging cohort longitudinally is unknown. METHODS We collected longitudinal diagnostic information (mean = 36 months) from patients assessed at a neuropsychiatry service, categorising diagnoses as ND/mild cognitive impairment/other neurological disorders (ND/MCI/other) and PSY. We pre-specified NfL > 582 pg/mL as indicative of ND/MCI/other. RESULTS Diagnostic category changed from initial to final diagnosis for 23% (49/212) of patients. NfL predicted the final diagnostic category for 92% (22/24) of these and predicted final diagnostic category overall (ND/MCI/other vs. PSY) in 88% (187/212), compared to 77% (163/212) with clinical assessment alone. CONCLUSIONS CSF NfL improved diagnostic accuracy, with potential to have led to earlier, accurate diagnosis in a real-world setting using a pre-specified cut-off, adding weight to translation of NfL into clinical practice.
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Affiliation(s)
- Matthew J Y Kang
- Neuropsychiatry, Royal Melbourne Hospital, Parkville, VIC, Australia
- Melbourne Neuropsychiatry Centre & Department of Psychiatry, University of Melbourne, Parkville, VIC, Australia
- Alfred Mental and Addiction Health, Alfred Health, Melbourne, VIC, Australia
| | - Dhamidhu Eratne
- Neuropsychiatry, Royal Melbourne Hospital, Parkville, VIC, Australia
- Melbourne Neuropsychiatry Centre & Department of Psychiatry, University of Melbourne, Parkville, VIC, Australia
| | - Hannah Dobson
- Neuropsychiatry, Royal Melbourne Hospital, Parkville, VIC, Australia
- Alfred Mental and Addiction Health, Alfred Health, Melbourne, VIC, Australia
| | - Charles B Malpas
- Department of Medicine, Royal Melbourne Hospital, Parkville, VIC, Australia
- Melbourne School of Psychological Sciences, University of Melbourne, Parkville, VIC, Australia
| | - Michael Keem
- Neuropsychiatry, Royal Melbourne Hospital, Parkville, VIC, Australia
- Melbourne Neuropsychiatry Centre & Department of Psychiatry, University of Melbourne, Parkville, VIC, Australia
| | - Courtney Lewis
- Neuropsychiatry, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Jasleen Grewal
- Alfred Mental and Addiction Health, Alfred Health, Melbourne, VIC, Australia
| | - Vivian Tsoukra
- Department of Neurology, Evangelismos Hospital, Athens, Greece
| | - Christa Dang
- National Ageing Research Institute, University of Melbourne, Parkville, VIC, Australia
| | | | - Tomas Kalincik
- Department of Medicine, Royal Melbourne Hospital, Parkville, VIC, Australia
- Department of Neurology, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Alexander F Santillo
- Department of Clinical Sciences Malmö, Clinical Memory Research Unit, Lund University, Lund, Sweden
- Memory Clinic, Skåne University Hospital, Malmo, Sweden
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
- Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, UK
- UK Dementia Research Institute at UCL, London, UK
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Christiane Stehmann
- The Australian National CJD Registry, The Florey Institute of Neuroscience and Mental Health, Melbourne, VIC, Australia
| | - Shiji Varghese
- National Dementia Diagnostic Laboratory, The Florey Institute of Neuroscience and Mental Health, Melbourne, VIC, Australia
| | - Qiao-Xin Li
- National Dementia Diagnostic Laboratory, The Florey Institute of Neuroscience and Mental Health, Melbourne, VIC, Australia
- Florey Department of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Colin L Masters
- Florey Department of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia
- The Florey Institute of Neuroscience and Mental Health, Parkville, VIC, Australia
| | - Steven Collins
- Department of Medicine, Royal Melbourne Hospital, Parkville, VIC, Australia
- National Dementia Diagnostic Laboratory, The Florey Institute of Neuroscience and Mental Health, Melbourne, VIC, Australia
| | - Samuel F Berkovic
- Department of Medicine, Austin Health, Epilepsy Research Centre, The University of Melbourne, Heidelberg, VIC, Australia
| | - Andrew Evans
- Neuropsychiatry, Royal Melbourne Hospital, Parkville, VIC, Australia
- Department of Neurology, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Wendy Kelso
- Neuropsychiatry, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Sarah Farrand
- Neuropsychiatry, Royal Melbourne Hospital, Parkville, VIC, Australia
- Melbourne Neuropsychiatry Centre & Department of Psychiatry, University of Melbourne, Parkville, VIC, Australia
| | - Samantha M Loi
- Neuropsychiatry, Royal Melbourne Hospital, Parkville, VIC, Australia
- Melbourne Neuropsychiatry Centre & Department of Psychiatry, University of Melbourne, Parkville, VIC, Australia
| | - Mark Walterfang
- Neuropsychiatry, Royal Melbourne Hospital, Parkville, VIC, Australia
- Melbourne Neuropsychiatry Centre & Department of Psychiatry, University of Melbourne, Parkville, VIC, Australia
- The Florey Institute of Neuroscience and Mental Health, Parkville, VIC, Australia
| | - Dennis Velakoulis
- Neuropsychiatry, Royal Melbourne Hospital, Parkville, VIC, Australia
- Melbourne Neuropsychiatry Centre & Department of Psychiatry, University of Melbourne, Parkville, VIC, Australia
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11
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Jassel OK, Tahir H, Bamford S, Giuffrida P. A Survey Exploring Inflammatory Back Pain in Patients With Inflammatory Bowel Disease. Cureus 2024; 16:e55264. [PMID: 38558651 PMCID: PMC10981531 DOI: 10.7759/cureus.55264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/29/2024] [Indexed: 04/04/2024] Open
Abstract
Background Diagnostic delay of axial spondyloarthritis (axSpA) is a widely recognized issue worldwide, providing a great burden for patients with this disease. AxSpA is present in a significant proportion of patients with inflammatory bowel disease (IBD). This UK study primarily aims to identify the presence of inflammatory back pain (IBP) in patients attending IBD clinic. Further aims of this study include investigating if participants had received further referrals and diagnoses for their IBP and considering factors contributing to diagnostic delay. Methods Patients were recruited from a Royal Free London NHS Trust hospital's IBD clinic. Each participant completed a 23-question survey. The Berlin criteria were applied to the questions to investigate the presence of IBP. Further questions were asked about their IBD diagnosis and treatment, the healthcare professionals they had seen for their back pain, and other extra-articular features associated with axSpA. Results Seventy-five patients completed the online survey sent out via email. Forty percent (n = 30) of participants were female and 60% (n = 45) were male. Sixty-one percent (n = 36) of participants from the colitis clinic reported they had back pain, and 41% of the participants reported back pain for over three months. Of these, 39% (12) of participants fulfilled the Berlin criteria for IBP. Of patients experiencing back pain for over three months, we found that 10% (3) fulfilled the Berlin criteria but had not received a diagnosis for their IBP. All patients who had fulfilled the Berlin criteria but had not received a diagnosis for their IBP had seen their general practitioner (GP) and an allied healthcare professional, but not a rheumatologist. Conclusions This study highlights the presence of possibly undiagnosed axSpA in patients with IBD. The reasons for the diagnostic delay of axSpA are multifactorial. We consider specific patient characteristics, lack of awareness and education of the condition, and issues in the referral process. There is a need to improve education and awareness of axSpA, reconsider referral processes, and consider new initiatives such as joint specialty clinics to identify and treat axSpA on time.
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Affiliation(s)
| | - Hasan Tahir
- Medicine, University College London, London, GBR
| | - Sian Bamford
- Physiotherapy, Royal Free London NHS Foundation Trust, London, GBR
| | - Paolo Giuffrida
- Gastroenterology, Royal Free London NHS Foundation Trust, London, GBR
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12
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Tanaka H, Shimaoka M. Emotional journey of patients with specified intractable diseases in Japan. Intractable Rare Dis Res 2024; 13:57-62. [PMID: 38404735 PMCID: PMC10883849 DOI: 10.5582/irdr.2023.01115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 01/05/2024] [Accepted: 01/11/2024] [Indexed: 02/27/2024] Open
Abstract
This study aimed to depict the emotional journey of Japanese patients with specific intractable diseases facing challenges associated with a delayed diagnosis. Specifically, our focus was on elucidating the emotional journey of patients and identifying the unmet needs caused by a delayed diagnosis. We conducted a web-based survey targeting 179 patients with 11 specified intractable diseases. They reported their emotional states during each journey phase using a 10-point scale. The results revealed that the period from noticing bodily changes to clinic visits was characterized by the most negative emotional states. Furthermore, the patients experienced a gradual shift towards positive emotional states as they decided to complete a consultation at a specialized hospital. They reached their most positive emotional states when they received a definitive diagnosis, subsequent treatment, and care. The thematic classification of emotional changes at the time of definitive diagnosis showed that "relief" was the most prevalent emotion (41.9%), followed by "no change" (19.9%), "anxiety" (14.0%), "shock" (13.4%), and "resignation" (6.5%). Additionally, when classifying the thematic changes in emotions during the period of bodily changes and clinic visits, "frustration" was the most common (51.3%), followed by "fear and anxiety" (43.6%). Patients tended to be most psychologically distressed during the period leading up to the definitive diagnosis. These results reveal that patients with intractable diseases are seeking a fast and accurate diagnosis, and that achieving these is a key unmet need for the patients.
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Affiliation(s)
- Hiroyuki Tanaka
- Graduate School of Health Innovation, Kanagawa University of Human Services, Kawasaki City, Japan
- CMIC Inizio Co., Ltd., Tokyo, Japan
| | - Mikiko Shimaoka
- Graduate School of Health Innovation, Kanagawa University of Human Services, Kawasaki City, Japan
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13
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Michelena X, Zhao SS, Marco-Pascual C, Almirall M, Collantes-Estevez E, Font-Ugalde P, López-Medina C, Wei JCC, Morgan AW, Rodríguez J, Juanola X, Vázquez-Mellado J, Marzo-Ortega H. Diagnostic delay is associated with uveitis and inflammatory bowel disease in AS: a study of extra-musculoskeletal manifestations in SpA. Rheumatology (Oxford) 2024; 63:430-435. [PMID: 37184889 PMCID: PMC10836992 DOI: 10.1093/rheumatology/kead225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 03/27/2023] [Accepted: 05/06/2023] [Indexed: 05/16/2023] Open
Abstract
OBJECTIVES To examine the prevalence of extra-musculoskeletal manifestations (EMM) and the association between diagnostic delay and their incidence in AS and PsA. METHODS This was a retrospective, cohort study comprising two single centre cohorts in Europe and one multicentre cohort in Latin America (RESPONDIA). Crude prevalence of EMMs (uveitis, IBD and psoriasis) was calculated across geographic area and adjusted by direct standardization. Cox proportional hazard analysis was performed to assess the association between diagnostic delay and EMM incidence. RESULTS Of 3553 patients, 2097 had AS and 1456 had PsA. The overall prevalence of uveitis was 22.9% (95% CI: 21.1, 24.8) in AS and 3.8% (95% CI: 2.9, 5.0) in PsA; 8.1% (95% CI: 7.0, 9.4) and 2.1% (1.3, 2.9), respectively, for IBD; and 11.0% (95% CI: 9.7, 12.4) and 94.6% (93.0, 95.9), respectively, for psoriasis. The EMM often presented before the arthritis (uveitis 45.1% and 33.3%, and IBD 37.4% and 70%, in AS and PsA, respectively). In the multivariable model, longer diagnostic delay (≥5 years) associated with more uveitis (hazard ratio [HR] 4.01; 95% CI: 3.23, 4.07) and IBD events (HR 1.85; 95% CI: 1.28, 2.67) in AS. Diagnostic delay was not significantly associated with uveitis (HR 1.57; 95% CI: 0.69, 3.59) or IBD events (HR 1.59; 95% CI: 0.39, 6.37) in PsA. CONCLUSION EMMs are more prevalent in AS than PsA and often present before the onset of the articular disease. A longer diagnostic delay is associated with the 'de novo' appearance of uveitis and IBD in AS, highlighting the need to enhance diagnostic strategies to shorten the time from first symptom to diagnosis in SpA.
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Affiliation(s)
- Xabier Michelena
- Rheumatology Unit, Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
- NIHR Leeds BRC, Leeds Teaching Hospitals NHS Trust and School of Medicine, University of Leeds, Leeds, UK
| | - Sizheng Steven Zhao
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Science, The University of Manchester, Manchester, UK
| | - Carla Marco-Pascual
- Rheumatology Unit, Hospital Dos de Maig—Consorci Sanitari Integral, Barcelona, Spain
- Rheumatology Unit, Bellvitge University Hospital, L’Hospitalet de Llobregat, Spain
| | - Miriam Almirall
- NIHR Leeds BRC, Leeds Teaching Hospitals NHS Trust and School of Medicine, University of Leeds, Leeds, UK
| | - Eduardo Collantes-Estevez
- Rheumatology Unit, Reina Sofia University Hospital and Maimonides Institute for Research in Biomedicine of Cordoba (IMIBIC), University of Córdoba, Córdoba, Spain
| | - Pilar Font-Ugalde
- Rheumatology Unit, Reina Sofia University Hospital and Maimonides Institute for Research in Biomedicine of Cordoba (IMIBIC), University of Córdoba, Córdoba, Spain
| | - Clementina López-Medina
- Rheumatology Unit, Reina Sofia University Hospital and Maimonides Institute for Research in Biomedicine of Cordoba (IMIBIC), University of Córdoba, Córdoba, Spain
| | - James Cheng-Chung Wei
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Ann W Morgan
- NIHR Leeds BRC, Leeds Teaching Hospitals NHS Trust and School of Medicine, University of Leeds, Leeds, UK
| | - Jesús Rodríguez
- Rheumatology Unit, Bellvitge University Hospital, L’Hospitalet de Llobregat, Spain
| | - Xavier Juanola
- Rheumatology Unit, Bellvitge University Hospital, L’Hospitalet de Llobregat, Spain
| | | | - Helena Marzo-Ortega
- NIHR Leeds BRC, Leeds Teaching Hospitals NHS Trust and School of Medicine, University of Leeds, Leeds, UK
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14
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Rider NL, Truxton A, Ohrt T, Margolin-Katz I, Horan M, Shin H, Davila R, Tenembaum V, Quinn J, Modell V, Modell F, Orange JS, Branner A, Senerchia C. Validating inborn error of immunity prevalence and risk with nationally representative electronic health record data. J Allergy Clin Immunol 2024:S0091-6749(24)00078-2. [PMID: 38278184 DOI: 10.1016/j.jaci.2024.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 01/17/2024] [Accepted: 01/18/2024] [Indexed: 01/28/2024]
Abstract
BACKGROUND The 10 Warning Signs of Primary Immunodeficiency were created 30 years ago to advance recognition of inborn errors of immunity (IEI). However, no population-level assessment of their utility applied to electronic health record (EHR) data has been conducted. OBJECTIVE We sought to quantify the value of having ≥2 warning signs (WS) toward diagnosing IEI using a highly representative real-world US cohort. A secondary goal was estimating the US prevalence of IEI. METHODS In this cohort study, we accessed normalized and de-identified EHR data on 152 million US patients. An IEI cohort (n = 41,080), in which patients were defined by having at least 1 verifiable IEI diagnosis placed ≥2 times in their record, was compared with a matched set of controls (n = 250,262). WS were encoded along with relevant diagnoses, relative weights were calculated, and the proportion of IEI cases versus controls with ≥2 WS was compared. RESULTS The proportion of IEI cases with ≥2 WS significantly differed from controls (0.33 vs 0.031; P < .0005, χ2 test). We also estimated a US IEI prevalence of 6 per 10,000 individuals (41,080/73,165,655; 0.056%). WS 9 (≥2 deep-seated infections), 7 (fungal infections), 5 (failure to thrive) and 4 (≥2 pneumonias in 1 year) were the most heavily weighted among the IEI cohort. CONCLUSIONS This nationally representative US-based cohort study demonstrates that presence of WS and associated clinical diagnoses can facilitate identification of patients with IEI from EHR data. In addition, we estimate that 6 in 10,000, or approximately 150,000 to 200,000 individuals are affected by IEI across the United States.
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Affiliation(s)
- Nicholas L Rider
- Department of Health Systems and Implementation Science, Virginia Tech Carilion School of Medicine, Roanoke, Va.
| | - Ahuva Truxton
- Optum Clinical Trial Solutions, Optum Life Sciences, Eden Prairie, Minn
| | - Tracy Ohrt
- Optum Clinical Trial Solutions, Optum Life Sciences, Eden Prairie, Minn
| | | | - Mary Horan
- Optum Clinical Trial Solutions, Optum Life Sciences, Eden Prairie, Minn
| | - Harold Shin
- Division of Clinical Informatics, Liberty University College of Osteopathic Medicine, Lynchburg, Va
| | | | | | | | | | | | - Jordan S Orange
- Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - Almut Branner
- Optum Clinical Trial Solutions, Optum Life Sciences, Eden Prairie, Minn
| | - Cynthia Senerchia
- Optum Clinical Trial Solutions, Optum Life Sciences, Eden Prairie, Minn
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15
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Sullivan J, Benítez A, Roth J, Andrews JS, Shah D, Butcher E, Jones A, Cross JH. A systematic literature review on the global epidemiology of Dravet syndrome and Lennox-Gastaut syndrome: Prevalence, incidence, diagnosis, and mortality. Epilepsia 2024. [PMID: 38252068 DOI: 10.1111/epi.17866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 12/14/2023] [Accepted: 12/14/2023] [Indexed: 01/23/2024]
Abstract
Dravet syndrome (DS) and Lennox-Gastaut syndrome (LGS) are rare developmental and epileptic encephalopathies associated with seizure and nonseizure symptoms. A comprehensive understanding of how many individuals are affected globally, the diagnostic journey they face, and the extent of mortality associated with these conditions is lacking. Here, we summarize and evaluate published data on the epidemiology of DS and LGS in terms of prevalence, incidence, diagnosis, genetic mutations, and mortality and sudden unexpected death in epilepsy (SUDEP) rates. The full study protocol is registered on PROSPERO (CRD42022316930). After screening 2172 deduplicated records, 91 unique records were included; 67 provided data on DS only, 17 provided data on LGS only, and seven provided data on both. Case definitions varied considerably across studies, particularly for LGS. Incidence and prevalence estimates per 100 000 individuals were generally higher for LGS than for DS (LGS: incidence proportion = 14.5-28, prevalence = 5.8-60.8; DS: incidence proportion = 2.2-6.5, prevalence = 1.2-6.5). Diagnostic delay was frequently reported for LGS, with a wider age range at diagnosis reported than for DS (DS, 1.6-9.2 years; LGS, 2-15 years). Genetic screening data were reported by 63 studies; all screened for SCN1A variants, and only one study specifically focused on individuals with LGS. Individuals with DS had a higher mortality estimate per 1000 person-years than individuals with LGS (DS, 15.84; LGS, 6.12) and a lower median age at death. SUDEP was the most frequently reported cause of death for individuals with DS. Only four studies reported mortality information for LGS, none of which included SUDEP. This systematic review highlights the paucity of epidemiological data available for DS and especially LGS, demonstrating the need for further research and adoption of standardized diagnostic criteria.
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Affiliation(s)
- Joseph Sullivan
- Department of Neurology, University of California, San Francisco, San Francisco, California, USA
| | - Arturo Benítez
- Takeda Development Center Americas, Cambridge, Massachusetts, USA
| | - Jeannine Roth
- Takeda Pharmaceuticals International, Zurich, Switzerland
| | - J Scott Andrews
- Takeda Development Center Americas, Cambridge, Massachusetts, USA
| | - Drishti Shah
- Takeda Development Center Americas, Cambridge, Massachusetts, USA
| | | | | | - J Helen Cross
- University College London, National Institute for Health and Care Research Biomedical Research Centre, London, UK
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16
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Zhou R, Sun X, Guo M, Zhang H, Chen X, Wu M, Liang H, Bai X, Ruan G, Yang H. A Shortened Diagnostic Interval and Its Associated Clinical Factors and Related Outcomes in Inflammatory Bowel Disease Patients from a Cohort Study in China. J Inflamm Res 2024; 17:387-398. [PMID: 38264424 PMCID: PMC10803283 DOI: 10.2147/jir.s434673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 01/09/2024] [Indexed: 01/25/2024] Open
Abstract
Aim The diagnosis of inflammatory bowel disease (IBD) worldwide is complicated and results in diagnostic delay. However, the diagnostic interval of IBD and the factors associated with diagnostic delay in patients in China have not been determined. Methods We retrospectively analyzed clinical data of hospitalized IBD patients in Peking Union Medical College Hospital from January 1998 to January 2018. Patients were divided into non-delayed and delayed groups according to their diagnostic interval. Results A total of 516 and 848 patients were confirmed to have Crohn's disease (CD) and ulcerative colitis (UC), respectively. The median diagnostic intervals were 6 and 20 months in patients with UC and CD, respectively (P<0.05). A decreasing trend in the diagnostic interval for IBD was observed over time, from 9 months to 1 month in UC patients and from 30 months to 3 months in CD patients. The longest diagnostic interval was 29.5 months in CD patients with first symptoms at the age of 51-60 years and 12.5 months in UC patients at the age of 41-50 years. In patients with CD, intestinal obstruction (OR=2.71), comorbid diabetes (OR=4.42), and appendectomy history (OR=2.18) were risk factors for diagnostic delay, whereas having fever as the first symptom may reduce its risk (OR=0.39). In patients with UC, the misdiagnosis of chronic enteritis (OR=2.10) was a risk factor for diagnostic delay. Conclusion The diagnostic interval for IBD has decreased over the years. Some clinical manifestations, such as initial symptoms and age at symptom onset, may help to shorten this interval. Diseases such as tuberculosis and infectious enteritis should be considered during differentiation.
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Affiliation(s)
- Runing Zhou
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy Medical Sciences and Peking Union Medical College, Beijing, 100730, People’s Republic of China
| | - Xiyu Sun
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy Medical Sciences and Peking Union Medical College, Beijing, 100730, People’s Republic of China
| | - Mingyue Guo
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy Medical Sciences and Peking Union Medical College, Beijing, 100730, People’s Republic of China
| | - Huimin Zhang
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy Medical Sciences and Peking Union Medical College, Beijing, 100730, People’s Republic of China
| | - Xuanfu Chen
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy Medical Sciences and Peking Union Medical College, Beijing, 100730, People’s Republic of China
| | - Meixu Wu
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy Medical Sciences and Peking Union Medical College, Beijing, 100730, People’s Republic of China
| | - Haozheng Liang
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy Medical Sciences and Peking Union Medical College, Beijing, 100730, People’s Republic of China
| | - Xiaoyin Bai
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy Medical Sciences and Peking Union Medical College, Beijing, 100730, People’s Republic of China
| | - Gechong Ruan
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy Medical Sciences and Peking Union Medical College, Beijing, 100730, People’s Republic of China
| | - Hong Yang
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy Medical Sciences and Peking Union Medical College, Beijing, 100730, People’s Republic of China
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17
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Carrillo-García J, Lacerenza S, Hindi N, García IC, Marquina G, Cano Cano JM, Trufero JM, Sevillano Tripero AR, Luis García T, Cuesta Rioboo MJ, Moura DS, Renshaw M, Mondaza-Hernández JL, Di Lernia D, Gutierrez A, Martin-Broto J. Delays in diagnosis and surgery of sarcoma patients during the COVID-19 outbreak in Spain. Ther Adv Med Oncol 2024; 16:17588359231220611. [PMID: 38205079 PMCID: PMC10777772 DOI: 10.1177/17588359231220611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 11/21/2023] [Indexed: 01/12/2024] Open
Abstract
Background and objectives Social distancing and quarantine implanted during the COVID-19 outbreak could have delayed the accession of oncologic patients to hospitals and treatments. This study analysed the management of sarcoma patients during this period in five Spanish hospitals. Design and methods Clinical data from adult sarcoma patients, soft tissue and bone sarcomas, managed during the COVID-19 outbreak, from 15 March to 14 September 2020 (Covid cohort), were retrospectively collected and time for diagnosis, surgery and active treatments were compared with sarcoma patients managed during the same pre-pandemic period in 2018 (Control cohort). Results A total of 126 and 182 new sarcoma patients were enrolled in the Covid and Control cohorts, respectively, who were mainly diagnosed as soft tissue sarcomas (81.0% and 80.8%) and at localized stage (80.2% and 79.1%). A diagnostic delay was observed in the Covid cohort with a median time for the diagnosis of 102.5 days (range 6-355) versus 83 days (range 5-328) in the Control cohort (p = 0.034). Moreover, a delay in surgery was observed in cases with localized disease from the Covid cohort with a median time of 96.0 days (range 11-265) versus 54.5 days (range 2-331) in the Control cohort (p = 0.034). However, a lower delay for neoadjuvant radiotherapy was observed in the Covid cohort with a median time from the diagnosis to the neoadjuvant radiotherapy of 47 days (range 27-105) versus 91 days (range 27-294) in the Control cohort (p = 0.039). No significant differences for adjuvant radiotherapy, neoadjuvant/adjuvant chemotherapy and neoadjuvant/adjuvant palliative chemotherapy were observed between both cohorts. Neither progression-free survival (PFS) nor overall survival (OS) was significantly different. Conclusion Delays in diagnosis and surgery were retrospectively observed in sarcoma patients during the COVID-19 outbreak in Spain, while the time for neoadjuvant radiotherapy was reduced. However, no impact on the PFS and OS was observed.
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Affiliation(s)
- Jaime Carrillo-García
- Health Research Institute Fundación Jiménez Díaz (IIS-FJD, UAM), Madrid, Spain
- Medical Oncology Department, University Hospital General de Villalba, Madrid, Spain
| | - Serena Lacerenza
- Institute of Biomedicine of Seville (IBIS), HUVR-CSIC-University of Seville, Seville, Spain
| | - Nadia Hindi
- Health Research Institute Fundación Jiménez Díaz (IIS-FJD, UAM), Madrid, Spain
- Medical Oncology Department, University Hospital General de Villalba, Madrid, Spain
- Medical Oncology Department, University Hospital Fundación Jiménez Díaz, Madrid, Spain
| | | | - Gloria Marquina
- Department of Medical Oncology, Hospital Clínico San Carlos, School of Medicine, Complutense University (UCM), IdISSC, Madrid, Spain
| | - Juana María Cano Cano
- Medical Oncology Department, University Hospital General de Ciudad Real, Ciudad Real, Spain
| | | | - Alberto Rafael Sevillano Tripero
- Medical Oncology Department, University Hospital General de Villalba, Madrid, Spain
- Medical Oncology Department, University Hospital Fundación Jiménez Díaz, Madrid, Spain
| | - Tania Luis García
- Department of Medical Oncology, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | | | - David S. Moura
- Health Research Institute Fundación Jiménez Díaz (IIS-FJD, UAM), Madrid, Spain
- Medical Oncology Department, University Hospital General de Villalba, Madrid, Spain
| | - Marta Renshaw
- Health Research Institute Fundación Jiménez Díaz (IIS-FJD, UAM), Madrid, Spain
- Medical Oncology Department, University Hospital General de Villalba, Madrid, Spain
| | - Jose L. Mondaza-Hernández
- Health Research Institute Fundación Jiménez Díaz (IIS-FJD, UAM), Madrid, Spain
- Medical Oncology Department, University Hospital General de Villalba, Madrid, Spain
| | - Davide Di Lernia
- Health Research Institute Fundación Jiménez Díaz (IIS-FJD, UAM), Madrid, Spain
- Medical Oncology Department, University Hospital General de Villalba, Madrid, Spain
| | - Antonio Gutierrez
- Department of Hematology, University Hospital Son Espases, Palma, Spain
| | - Javier Martin-Broto
- Health Research Institute Fundación Jiménez Díaz (IIS-FJD, UAM), Reyes Católicos 2, Madrid 28040, Spain
- Medical Oncology Department, University Hospital General de Villalba, Madrid, Spain
- Medical Oncology Department, University Hospital Fundación Jiménez Díaz, Madrid, Spain
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de Chauveron J, Unger M, Lescaille G, Wendling L, Kurtz C, Rochefort J. Artificial intelligence for oral squamous cell carcinoma detection based on oral photographs: A comprehensive literature review. Cancer Med 2024; 13:e6822. [PMID: 38164652 PMCID: PMC10807632 DOI: 10.1002/cam4.6822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 12/01/2023] [Accepted: 12/04/2023] [Indexed: 01/03/2024] Open
Abstract
INTRODUCTION Oral squamous cell carcinoma (OSCC) presents a significant global health challenge. The integration of artificial intelligence (AI) and computer vision holds promise for the early detection of OSCC through the analysis of digitized oral photographs. This literature review explores the landscape of AI-driven OSCC automatic detection, assessing both the performance and limitations of the current state of the art. MATERIALS AND METHODS An electronic search using several data base was conducted, and a systematic review performed in accordance with PRISMA guidelines (CRD42023441416). RESULTS Several studies have demonstrated remarkable results for this task, consistently achieving sensitivity rates exceeding 85% and accuracy rates surpassing 90%, often encompassing around 1000 images. The review scrutinizes these studies, shedding light on their methodologies, including the use of recent machine learning and pattern recognition approaches coupled with different supervision strategies. However, comparing the results from different papers is challenging due to variations in the datasets used. DISCUSSION Considering these findings, this review underscores the urgent need for more robust and reliable datasets in the field of OSCC detection. Furthermore, it highlights the potential of advanced techniques such as multi-task learning, attention mechanisms, and ensemble learning as crucial tools in enhancing the accuracy and sensitivity of OSCC detection through oral photographs. CONCLUSION These insights collectively emphasize the transformative impact of AI-driven approaches on early OSCC diagnosis, with the potential to significantly improve patient outcomes and healthcare practices.
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Affiliation(s)
- Jérôme de Chauveron
- Equipe Microenvironnement Immunitaire et Immunothérapie, CIMI Paris, INSERM U1135Sorbonne universitéPARISFrance
- UFR Mathématiques et Informatique, département informatique, laboratoire LIPADEUniversité Paris CitéParisFrance
- ANALOGIES
| | | | - Géraldine Lescaille
- Equipe Microenvironnement Immunitaire et Immunothérapie, CIMI Paris, INSERM U1135Sorbonne universitéPARISFrance
- UFR d'OdontologieUniversité Paris CitéParisFrance
- Département de Médecine bucco‐dentaireHôpital Pitié Salpêtrière, APHPPARISFrance
| | - Laurent Wendling
- UFR Mathématiques et Informatique, département informatique, laboratoire LIPADEUniversité Paris CitéParisFrance
| | - Camille Kurtz
- UFR Mathématiques et Informatique, département informatique, laboratoire LIPADEUniversité Paris CitéParisFrance
| | - Juliette Rochefort
- Equipe Microenvironnement Immunitaire et Immunothérapie, CIMI Paris, INSERM U1135Sorbonne universitéPARISFrance
- UFR d'OdontologieUniversité Paris CitéParisFrance
- Département de Médecine bucco‐dentaireHôpital Pitié Salpêtrière, APHPPARISFrance
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Zheng X, Chen Z, Wu X, Xie Y, Wu J, Xiao M, Yang M, Tu L, Cao S, Wei Q, Gu J. Diagnostic delay and its associated factors in Chinese axial spondyloarthritis: A single-center study of 1295 patients. Int J Rheum Dis 2024; 27:e14975. [PMID: 37965927 DOI: 10.1111/1756-185x.14975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 10/23/2023] [Accepted: 10/30/2023] [Indexed: 11/16/2023]
Abstract
AIM To delineate the landscape of diagnostic delay in Chinese axial spondyloarthritis (axSpA), investigate its associated factors, and explore its potential impact on medication modalities. METHODS A total of 1295 patients fulfilling the ASAS classification criteria were obtained. Demographic and clinical data were collected through face-to-face interviews, based on predesigned questionnaires and available medical records. Logistic regression analyses under univariate and multivariable model were performed, using the median of diagnostic delay as the cut-off point for group classification. Differences between early- and late-diagnosed groups were subsequently compared by the Pearson chi-square test or Mann-Whitney U test. RESULTS Of 1295 axSpA patients, 80.3% were male and the median of disease duration was 8.0 years. The median (IQR) diagnostic delay in Chinese axSpA was 3.0 (1.0 ~ 7.0) years and 24.8% of them reported a history of misdiagnosis. Older age at onset (OR = 0.97, p < .001) and higher education attainment (p = .001) were correlated with early diagnosis of axSpA, whereas coming from less developed areas (p = .002), a history of peripheral arthritis at the time of diagnosis (OR = 1.58, p = .002) and history of misdiagnosis (OR = 1.98, p < .001) increased the risk of diagnostic delay. Oral medication modalities were similar between two groups, but the proportion with no medication ever was higher in the late-diagnosed group (26.5% vs. 20.7%, p = .02). CONCLUSION Our findings depicted a detailed spectrum of diagnostic delay in Chinese axSpA, verified five associated factors that may help facilitate timely diagnosis of axSpA, and pinpointed that timely medication was unsatisfying, especially in the late diagnosis group.
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Affiliation(s)
- Xuqi Zheng
- Department of Rheumatology and Immunology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- The Guangdong Clinical Research Center of Immune Disease, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zena Chen
- Department of Rheumatology and Immunology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- The Guangdong Clinical Research Center of Immune Disease, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xinyu Wu
- Department of Rheumatology and Immunology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- The Guangdong Clinical Research Center of Immune Disease, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Ya Xie
- Department of Rheumatology and Immunology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- The Guangdong Clinical Research Center of Immune Disease, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jialing Wu
- Department of Rheumatology and Immunology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- The Guangdong Clinical Research Center of Immune Disease, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Min Xiao
- Department of Rheumatology and Immunology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- The Guangdong Clinical Research Center of Immune Disease, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Mingcan Yang
- Department of Rheumatology and Immunology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- The Guangdong Clinical Research Center of Immune Disease, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Liudan Tu
- Department of Rheumatology and Immunology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- The Guangdong Clinical Research Center of Immune Disease, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Shuangyan Cao
- Department of Rheumatology and Immunology, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Qiujing Wei
- Department of Rheumatology and Immunology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- The Guangdong Clinical Research Center of Immune Disease, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jieruo Gu
- Department of Rheumatology and Immunology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- The Guangdong Clinical Research Center of Immune Disease, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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20
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Bermudo G, Roman-Rodriguez M, Molina-Molina M. Interstitial lung diseases: never forget to think about it in primary care. Expert Rev Respir Med 2024; 18:9-15. [PMID: 38486433 DOI: 10.1080/17476348.2024.2331763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 03/13/2024] [Indexed: 03/20/2024]
Affiliation(s)
- Guadalupe Bermudo
- ILD Unit, Respiratory Department, University Hospital of Bellvitge, IDIBELL, University of Barcelona, Hospitalet de Llobregat, Barcelona, Spain
- Respiratory Diseases Network Research Consortium (CIBERES), Spain
| | - Miguel Roman-Rodriguez
- Primary Care Respiratory Research Unit, Instituto de Investigación Sanitaria de Baleares (IdISBa), Palma de Mallorca, Spain
- Son Pisa Primary Care health centre, Palma de Mallorca, Spain
| | - Maria Molina-Molina
- ILD Unit, Respiratory Department, University Hospital of Bellvitge, IDIBELL, University of Barcelona, Hospitalet de Llobregat, Barcelona, Spain
- Respiratory Diseases Network Research Consortium (CIBERES), Spain
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21
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Yue D, Jiao K, Xia X, Zhang J, Zhu B, Liu L, Du K, Gao M, Cheng N, Wang N, Luo S, Xi J, Lu J, Zhao C, Zhu W. Diagnostic delay in late-onset Pompe disease among Chinese patients: A retrospective study. JIMD Rep 2024; 65:39-46. [PMID: 38186848 PMCID: PMC10764198 DOI: 10.1002/jmd2.12404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 11/24/2023] [Accepted: 11/29/2023] [Indexed: 01/09/2024] Open
Abstract
Surveys and retrospective studies have revealed considerable delays in diagnosing late-onset Pompe disease (LOPD) in China, where the contributing factors remain poorly represented. Our study analyzed the diagnostic journey of 34 LOPD patients seen at our neuromuscular clinic from 2005 to 2022. We defined diagnostic delay as the time from the onset of the first relevant symptoms and laboratory findings suggestive of LOPD to the eventual diagnosis, and we constructed a correlation matrix to assess relationships among these variables. The cohort consisted of 34 patients with an equal male-to-female ratio, and the mean age at diagnosis was 27.68 ± 10.03 years. We found the median diagnostic delay to be 5 years, with a range of 0.3 to 20 years, with 97.1% having been misdiagnosed previously, most commonly with "Type II Respiratory insufficiency" (36.7%). Notably, patients at earlier onset (mean age, 18.19 years vs. 31 years; p < 0.005) tended to have higher creatine kinase (CK) levels. Furthermore, 92.6% reported difficulty in sitting up from a supine position since childhood. Our research emphasizes the role of early indicators like dyspnea and difficulty performing sit-ups in adolescents for timely LOPD diagnosis and treatment initiation. The importance of early high-risk screening using dried blood spot testing cannot be overstated.
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Affiliation(s)
- Dongyue Yue
- Department of NeurologyJing'an District Center Hospital of ShanghaiShanghaiChina
| | - Kexin Jiao
- Department of NeurologyHuashan Hospital, Fudan UniversityShanghaiChina
- National Center for Neurological Disorders (NCND)ShanghaiChina
- Huashan Rare Disease CenterShanghai Medical College, Huashan Hospital, Fudan UniversityShanghaiChina
| | - Xingyu Xia
- Department of NeurologyHuashan Hospital, Fudan UniversityShanghaiChina
- National Center for Neurological Disorders (NCND)ShanghaiChina
- Huashan Rare Disease CenterShanghai Medical College, Huashan Hospital, Fudan UniversityShanghaiChina
| | - Jialong Zhang
- Department of NeurologyHuashan Hospital, Fudan UniversityShanghaiChina
- National Center for Neurological Disorders (NCND)ShanghaiChina
- Huashan Rare Disease CenterShanghai Medical College, Huashan Hospital, Fudan UniversityShanghaiChina
| | - Bochen Zhu
- Department of NeurologyHuashan Hospital, Fudan UniversityShanghaiChina
- National Center for Neurological Disorders (NCND)ShanghaiChina
- Huashan Rare Disease CenterShanghai Medical College, Huashan Hospital, Fudan UniversityShanghaiChina
| | - Lingchun Liu
- The First People's Hospital of Yunnan ProvinceYunnanChina
| | - Kunzhao Du
- Jinshan Hospital Center for Neurosurgery, Jinshan Hospital, Institute for Translational Brain Research, State Key Laboratory of Medical Neurobiology, MOE Frontiers Center for Brain ScienceFudan UniversityShanghaiChina
| | - Mingshi Gao
- Department of PathologyHuashan Hospital, Fudan UniversityShanghaiChina
| | - Nachuan Cheng
- Department of NeurologyHuashan Hospital, Fudan UniversityShanghaiChina
- National Center for Neurological Disorders (NCND)ShanghaiChina
- Huashan Rare Disease CenterShanghai Medical College, Huashan Hospital, Fudan UniversityShanghaiChina
| | - Ningning Wang
- Department of NeurologyHuashan Hospital, Fudan UniversityShanghaiChina
- National Center for Neurological Disorders (NCND)ShanghaiChina
- Huashan Rare Disease CenterShanghai Medical College, Huashan Hospital, Fudan UniversityShanghaiChina
| | - Sushan Luo
- Department of NeurologyHuashan Hospital, Fudan UniversityShanghaiChina
- National Center for Neurological Disorders (NCND)ShanghaiChina
- Huashan Rare Disease CenterShanghai Medical College, Huashan Hospital, Fudan UniversityShanghaiChina
| | - Jianying Xi
- Department of NeurologyHuashan Hospital, Fudan UniversityShanghaiChina
- National Center for Neurological Disorders (NCND)ShanghaiChina
- Huashan Rare Disease CenterShanghai Medical College, Huashan Hospital, Fudan UniversityShanghaiChina
| | - Jiahong Lu
- Department of NeurologyHuashan Hospital, Fudan UniversityShanghaiChina
- National Center for Neurological Disorders (NCND)ShanghaiChina
- Huashan Rare Disease CenterShanghai Medical College, Huashan Hospital, Fudan UniversityShanghaiChina
| | - Chongbo Zhao
- Department of NeurologyHuashan Hospital, Fudan UniversityShanghaiChina
- National Center for Neurological Disorders (NCND)ShanghaiChina
- Huashan Rare Disease CenterShanghai Medical College, Huashan Hospital, Fudan UniversityShanghaiChina
| | - Wenhua Zhu
- Department of NeurologyHuashan Hospital, Fudan UniversityShanghaiChina
- National Center for Neurological Disorders (NCND)ShanghaiChina
- Huashan Rare Disease CenterShanghai Medical College, Huashan Hospital, Fudan UniversityShanghaiChina
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Supehia S, Singh M, Bahurupi Y, Aggarwal P, Chandra R, Sharma N. The Extent of Delay in Diagnosis, Treatment and their Associated Factors among Tuberculosis Patients Attending Government Hospitals of Rishikesh, Uttarakhand: A Cross-Sectional Study. Recent Adv Antiinfect Drug Discov 2024; 19:137-147. [PMID: 37198982 DOI: 10.2174/2772434418666230517151828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 03/29/2023] [Accepted: 04/04/2023] [Indexed: 05/19/2023]
Abstract
BACKGROUND "Tuberculosis (TB) remains a major public health problem" worldwide, affecting almost all age groups. "Early diagnosis and prompt treatment are essential to significantly reducing the TB burden." However, a significant proportion of cases remain undiagnosed and untreated, which plays a vital role in the transmission of the disease and severity of the illness in the community in most developing countries. AIMS & OBJECTIVES This study aimed to assess "the extent of delay in diagnosis and treatment of TB patients" and to identify the major factors associated with such delays (whether patient or health system-related) among TB patients in Rishikesh. METHODS This descriptive cross-sectional study was conducted in Rishikesh Town, Dehradun District, Uttara khand, India. Total of 130 newly diagnosed TB patients were recruited as study participants who attended the government hospitals of Rishikesh, All India Institute of Medical Sciences, Rishikesh and S P S Government Hospital, Rishikesh. A universal sampling technique was used in this study. RESULTS The mean age of the study participant was 36.75 (Standard Deviation (SD), 17.6), and the median age was 34 years. Of the patients, 64.6% were men, and 35.4% were women. The extent of various delays, such as patient delay (median 16 days), diagnostic delay (median 78.5 days), treatment delay (median 4 days), health system delay (43 days), and total delay (median 81 days). CONCLUSION The misconception of any chronic disease may lead to a false diagnosis or long treatment for symptomatic relief; the absence of proper diagnostic tests and doctor shopping could be the reasons for the prolonged diagnostic delay. Therefore, by strengthening the collaboration between private and public practitioners in order to meet the expectations of the Government of India to achieve the goals of the "National Strategic Plan for ending TB" in India by providing good quality care for all patients.
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Affiliation(s)
- Sakshi Supehia
- Department of Community Medicine, Dr. Rajendra Prasad Government Medical College, Kangra, Himachal Pradesh, India
| | - Mahendra Singh
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Rishikesh, India
| | - Yogesh Bahurupi
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Rishikesh, India
| | - Pradeep Aggarwal
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Rishikesh, India
| | - Rishita Chandra
- School of Medicine, University of Tasmania, Tasmania, Australia
| | - Nandita Sharma
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Rishikesh, India
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Khassoui AE, Attibbi M, Touraif M, Aghoutane EM, Salama T, Fezzazi RE. An Uncommon Presentation of Osteosarcoma in a Child: A Case Report. J Orthop Case Rep 2024; 14:44-47. [PMID: 38292089 PMCID: PMC10823806 DOI: 10.13107/jocr.2024.v14.i01.4142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 11/26/2023] [Indexed: 02/01/2024] Open
Abstract
Introduction Osteosarcoma is the most common primary malignant bone tumor in childhood distinguished by its clinical aspects, epidemiological features, and radiological and histological findings. Around 10% of patients present with distant metastasis at the most frequent sites, which are lungs and bone. Furthermore, death rates for osteosarcoma have been declining by about 1.3% per year. Case Report We report the case of a 12-year-old child who presented to the emergency department with a large thigh hematoma, and after running all the necessary clinical investigations, it turned out to be secondary to femoral osteosarcoma. Conclusion In this case, our aim is to highlight the unusual clinical manifestations observed in a child with osteosarcoma, which can lead to a diagnosis delay and the subsequent impact on prognosis.
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Affiliation(s)
- Amine El Khassoui
- Department of Pediatric Orthopedic, Mother and Child Unit, University Hospital Mohamed VI of Marrakech, Faculty of Medicine and Pharmacy, Cadi Ayyad University, Marrakech, Morocco
| | - Maha Attibbi
- Department of Pediatric Orthopedic, Mother and Child Unit, University Hospital Mohamed VI of Marrakech, Faculty of Medicine and Pharmacy, Cadi Ayyad University, Marrakech, Morocco
| | - Mariem Touraif
- Department of Pediatric Orthopedic, Mother and Child Unit, University Hospital Mohamed VI of Marrakech, Faculty of Medicine and Pharmacy, Cadi Ayyad University, Marrakech, Morocco
| | - El Mouhtadi Aghoutane
- Department of Pediatric Orthopedic, Mother and Child Unit, University Hospital Mohamed VI of Marrakech, Faculty of Medicine and Pharmacy, Cadi Ayyad University, Marrakech, Morocco
| | - Tarik Salama
- Department of Pediatric Orthopedic, Mother and Child Unit, University Hospital Mohamed VI of Marrakech, Faculty of Medicine and Pharmacy, Cadi Ayyad University, Marrakech, Morocco
| | - Redouane El Fezzazi
- Department of Pediatric Orthopedic, Mother and Child Unit, University Hospital Mohamed VI of Marrakech, Faculty of Medicine and Pharmacy, Cadi Ayyad University, Marrakech, Morocco
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24
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Small M, Perchenet L, Bennett A, Linder J. The diagnostic journey of pulmonary arterial hypertension patients: results from a multinational real-world survey. Ther Adv Respir Dis 2024; 18:17534666231218886. [PMID: 38357903 PMCID: PMC10870813 DOI: 10.1177/17534666231218886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 11/17/2023] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Pulmonary arterial hypertension (PAH) is a life-threatening, progressive disease often diagnosed late in its course. OBJECTIVES To present patient-reported data that were captured within a large, multinational, point-in-time survey of PAH-treating physicians and their patients to better understand the diagnostic journey. DESIGN Cross-sectional survey conducted in five European countries (EU5), Japan and the USA. METHODS PAH-treating pulmonologists, cardiologists, rheumatologists or internists (USA only) completed a patient record form (PRF) for the next four consecutive adult PAH patients they saw; these patients filled in a patient self-completion (PSC) form on an anonymous, voluntary basis. Our report focuses on patient data; data are from PSC forms unless stated otherwise. RESULTS Physician-reported PRFs and self-completed PSC forms were obtained for 1152 and 572 patients, respectively. Patients' mean (SD) age was 59.1 (14.0) years, 55.6% were female, and 57.3% had idiopathic PAH. Patient-reported data showed an average delay of 17.0 months between symptom onset and PAH diagnosis. This is longer than physicians estimated (13.8 months): this disparity may be partly due to the time taken by patients to consult a physician about their symptoms [9.6 months overall, longest in the USA (15.3 months)]. Most patients (71.6%) initially consulted primary care physicians about their symptoms and 76.4% of patients were referred to a specialist. Misdiagnoses occurred in 40.9% of patients [most frequent in the USA (51.3%), least common in Japan (27.6%)] and they saw an average of 2.9 physicians overall (3.5 in EU5 versus 2.0 in Japan/USA) before being diagnosed. Diagnosis was most often made by cardiologists (50.4%) or pulmonologists (49.3%). CONCLUSION Our data suggest that diagnostic delay in PAH results from patient- and physician-related factors, which differ across regions and include lack of awareness of PAH on both sides. Development of better screening strategies may help address this barrier to timely PAH diagnosis.
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Affiliation(s)
- Mark Small
- Respiratory Franchise, Adelphi Real World, Adelphi Mill, Grimshaw Ln, Bollington, Macclesfield, SK10 5JB, UK
| | - Loïc Perchenet
- Medical Affairs, Actelion Pharmaceuticals Ltd, a Janssen Pharmaceutical Company of Johnson & Johnson, Allschwil, Switzerland
| | - Alex Bennett
- Respiratory Franchise, Adelphi Real World, Bollington, UK
| | - Jörg Linder
- Market Access, Janssen-Cilag GmbH, Neuss, Germany
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25
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Han E, Nabity SA, Dasgupta-Tsinikas S, Guevara RE, Moore M, Kadakia A, Henry H, Cilnis M, Buhain S, Chitnis A, Chakrabarty M, Ky A, Nguyen Q, Low J, Jain S, Higashi J, Barry PM, Flood J. Tuberculosis Diagnostic Delays and Treatment Outcomes among Patients with COVID-19, California, USA, 2020. Emerg Infect Dis 2024; 30:136-140. [PMID: 38147063 PMCID: PMC10756354 DOI: 10.3201/eid3001.230924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2023] Open
Abstract
We assessed tuberculosis (TB) diagnostic delays among patients with TB and COVID-19 in California, USA. Among 58 persons, 43% experienced TB diagnostic delays, and a high proportion (83%) required hospitalization for TB. Even when viral respiratory pathogens circulate widely, timely TB diagnostic workup for at-risk persons remains critical for reducing TB-related illness.
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Affiliation(s)
| | | | - Shom Dasgupta-Tsinikas
- California Department of Public Health, Richmond, California, USA (E. Han, S.A. Nabity, H. Henry, M. Cilnis, S. Jain, P.M. Barry, J. Flood)
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S.A. Nabity, M. Moore)
- Los Angeles County Department of Public Health, Los Angeles, California, USA (S. Dasgupta-Tsinikas, R.E. Guevara, J. Higashi)
- San Diego County Health and Human Services Agency, San Diego, California, USA (M. Moore, A. Kadakia)
- Alameda County Public Health Department, San Leandro, California, USA (S. Buhain, A. Chitnis)
- Sacramento County Health Services, Sacramento, California, USA (M. Chakrabarty)
- Santa Clara County Public Health Department, San Jose, California, USA (A. Ky)
- Orange County Health Care Agency, Santa Ana, California, USA (Q. Nguyen, J. Low)
| | - Ramon E. Guevara
- California Department of Public Health, Richmond, California, USA (E. Han, S.A. Nabity, H. Henry, M. Cilnis, S. Jain, P.M. Barry, J. Flood)
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S.A. Nabity, M. Moore)
- Los Angeles County Department of Public Health, Los Angeles, California, USA (S. Dasgupta-Tsinikas, R.E. Guevara, J. Higashi)
- San Diego County Health and Human Services Agency, San Diego, California, USA (M. Moore, A. Kadakia)
- Alameda County Public Health Department, San Leandro, California, USA (S. Buhain, A. Chitnis)
- Sacramento County Health Services, Sacramento, California, USA (M. Chakrabarty)
- Santa Clara County Public Health Department, San Jose, California, USA (A. Ky)
- Orange County Health Care Agency, Santa Ana, California, USA (Q. Nguyen, J. Low)
| | - Marisa Moore
- California Department of Public Health, Richmond, California, USA (E. Han, S.A. Nabity, H. Henry, M. Cilnis, S. Jain, P.M. Barry, J. Flood)
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S.A. Nabity, M. Moore)
- Los Angeles County Department of Public Health, Los Angeles, California, USA (S. Dasgupta-Tsinikas, R.E. Guevara, J. Higashi)
- San Diego County Health and Human Services Agency, San Diego, California, USA (M. Moore, A. Kadakia)
- Alameda County Public Health Department, San Leandro, California, USA (S. Buhain, A. Chitnis)
- Sacramento County Health Services, Sacramento, California, USA (M. Chakrabarty)
- Santa Clara County Public Health Department, San Jose, California, USA (A. Ky)
- Orange County Health Care Agency, Santa Ana, California, USA (Q. Nguyen, J. Low)
| | - Ankita Kadakia
- California Department of Public Health, Richmond, California, USA (E. Han, S.A. Nabity, H. Henry, M. Cilnis, S. Jain, P.M. Barry, J. Flood)
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S.A. Nabity, M. Moore)
- Los Angeles County Department of Public Health, Los Angeles, California, USA (S. Dasgupta-Tsinikas, R.E. Guevara, J. Higashi)
- San Diego County Health and Human Services Agency, San Diego, California, USA (M. Moore, A. Kadakia)
- Alameda County Public Health Department, San Leandro, California, USA (S. Buhain, A. Chitnis)
- Sacramento County Health Services, Sacramento, California, USA (M. Chakrabarty)
- Santa Clara County Public Health Department, San Jose, California, USA (A. Ky)
- Orange County Health Care Agency, Santa Ana, California, USA (Q. Nguyen, J. Low)
| | - Hannah Henry
- California Department of Public Health, Richmond, California, USA (E. Han, S.A. Nabity, H. Henry, M. Cilnis, S. Jain, P.M. Barry, J. Flood)
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S.A. Nabity, M. Moore)
- Los Angeles County Department of Public Health, Los Angeles, California, USA (S. Dasgupta-Tsinikas, R.E. Guevara, J. Higashi)
- San Diego County Health and Human Services Agency, San Diego, California, USA (M. Moore, A. Kadakia)
- Alameda County Public Health Department, San Leandro, California, USA (S. Buhain, A. Chitnis)
- Sacramento County Health Services, Sacramento, California, USA (M. Chakrabarty)
- Santa Clara County Public Health Department, San Jose, California, USA (A. Ky)
- Orange County Health Care Agency, Santa Ana, California, USA (Q. Nguyen, J. Low)
| | - Martin Cilnis
- California Department of Public Health, Richmond, California, USA (E. Han, S.A. Nabity, H. Henry, M. Cilnis, S. Jain, P.M. Barry, J. Flood)
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S.A. Nabity, M. Moore)
- Los Angeles County Department of Public Health, Los Angeles, California, USA (S. Dasgupta-Tsinikas, R.E. Guevara, J. Higashi)
- San Diego County Health and Human Services Agency, San Diego, California, USA (M. Moore, A. Kadakia)
- Alameda County Public Health Department, San Leandro, California, USA (S. Buhain, A. Chitnis)
- Sacramento County Health Services, Sacramento, California, USA (M. Chakrabarty)
- Santa Clara County Public Health Department, San Jose, California, USA (A. Ky)
- Orange County Health Care Agency, Santa Ana, California, USA (Q. Nguyen, J. Low)
| | - Sonal Buhain
- California Department of Public Health, Richmond, California, USA (E. Han, S.A. Nabity, H. Henry, M. Cilnis, S. Jain, P.M. Barry, J. Flood)
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S.A. Nabity, M. Moore)
- Los Angeles County Department of Public Health, Los Angeles, California, USA (S. Dasgupta-Tsinikas, R.E. Guevara, J. Higashi)
- San Diego County Health and Human Services Agency, San Diego, California, USA (M. Moore, A. Kadakia)
- Alameda County Public Health Department, San Leandro, California, USA (S. Buhain, A. Chitnis)
- Sacramento County Health Services, Sacramento, California, USA (M. Chakrabarty)
- Santa Clara County Public Health Department, San Jose, California, USA (A. Ky)
- Orange County Health Care Agency, Santa Ana, California, USA (Q. Nguyen, J. Low)
| | - Amit Chitnis
- California Department of Public Health, Richmond, California, USA (E. Han, S.A. Nabity, H. Henry, M. Cilnis, S. Jain, P.M. Barry, J. Flood)
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S.A. Nabity, M. Moore)
- Los Angeles County Department of Public Health, Los Angeles, California, USA (S. Dasgupta-Tsinikas, R.E. Guevara, J. Higashi)
- San Diego County Health and Human Services Agency, San Diego, California, USA (M. Moore, A. Kadakia)
- Alameda County Public Health Department, San Leandro, California, USA (S. Buhain, A. Chitnis)
- Sacramento County Health Services, Sacramento, California, USA (M. Chakrabarty)
- Santa Clara County Public Health Department, San Jose, California, USA (A. Ky)
- Orange County Health Care Agency, Santa Ana, California, USA (Q. Nguyen, J. Low)
| | - Melony Chakrabarty
- California Department of Public Health, Richmond, California, USA (E. Han, S.A. Nabity, H. Henry, M. Cilnis, S. Jain, P.M. Barry, J. Flood)
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S.A. Nabity, M. Moore)
- Los Angeles County Department of Public Health, Los Angeles, California, USA (S. Dasgupta-Tsinikas, R.E. Guevara, J. Higashi)
- San Diego County Health and Human Services Agency, San Diego, California, USA (M. Moore, A. Kadakia)
- Alameda County Public Health Department, San Leandro, California, USA (S. Buhain, A. Chitnis)
- Sacramento County Health Services, Sacramento, California, USA (M. Chakrabarty)
- Santa Clara County Public Health Department, San Jose, California, USA (A. Ky)
- Orange County Health Care Agency, Santa Ana, California, USA (Q. Nguyen, J. Low)
| | - Ann Ky
- California Department of Public Health, Richmond, California, USA (E. Han, S.A. Nabity, H. Henry, M. Cilnis, S. Jain, P.M. Barry, J. Flood)
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S.A. Nabity, M. Moore)
- Los Angeles County Department of Public Health, Los Angeles, California, USA (S. Dasgupta-Tsinikas, R.E. Guevara, J. Higashi)
- San Diego County Health and Human Services Agency, San Diego, California, USA (M. Moore, A. Kadakia)
- Alameda County Public Health Department, San Leandro, California, USA (S. Buhain, A. Chitnis)
- Sacramento County Health Services, Sacramento, California, USA (M. Chakrabarty)
- Santa Clara County Public Health Department, San Jose, California, USA (A. Ky)
- Orange County Health Care Agency, Santa Ana, California, USA (Q. Nguyen, J. Low)
| | - Quy Nguyen
- California Department of Public Health, Richmond, California, USA (E. Han, S.A. Nabity, H. Henry, M. Cilnis, S. Jain, P.M. Barry, J. Flood)
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S.A. Nabity, M. Moore)
- Los Angeles County Department of Public Health, Los Angeles, California, USA (S. Dasgupta-Tsinikas, R.E. Guevara, J. Higashi)
- San Diego County Health and Human Services Agency, San Diego, California, USA (M. Moore, A. Kadakia)
- Alameda County Public Health Department, San Leandro, California, USA (S. Buhain, A. Chitnis)
- Sacramento County Health Services, Sacramento, California, USA (M. Chakrabarty)
- Santa Clara County Public Health Department, San Jose, California, USA (A. Ky)
- Orange County Health Care Agency, Santa Ana, California, USA (Q. Nguyen, J. Low)
| | - Julie Low
- California Department of Public Health, Richmond, California, USA (E. Han, S.A. Nabity, H. Henry, M. Cilnis, S. Jain, P.M. Barry, J. Flood)
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S.A. Nabity, M. Moore)
- Los Angeles County Department of Public Health, Los Angeles, California, USA (S. Dasgupta-Tsinikas, R.E. Guevara, J. Higashi)
- San Diego County Health and Human Services Agency, San Diego, California, USA (M. Moore, A. Kadakia)
- Alameda County Public Health Department, San Leandro, California, USA (S. Buhain, A. Chitnis)
- Sacramento County Health Services, Sacramento, California, USA (M. Chakrabarty)
- Santa Clara County Public Health Department, San Jose, California, USA (A. Ky)
- Orange County Health Care Agency, Santa Ana, California, USA (Q. Nguyen, J. Low)
| | - Seema Jain
- California Department of Public Health, Richmond, California, USA (E. Han, S.A. Nabity, H. Henry, M. Cilnis, S. Jain, P.M. Barry, J. Flood)
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S.A. Nabity, M. Moore)
- Los Angeles County Department of Public Health, Los Angeles, California, USA (S. Dasgupta-Tsinikas, R.E. Guevara, J. Higashi)
- San Diego County Health and Human Services Agency, San Diego, California, USA (M. Moore, A. Kadakia)
- Alameda County Public Health Department, San Leandro, California, USA (S. Buhain, A. Chitnis)
- Sacramento County Health Services, Sacramento, California, USA (M. Chakrabarty)
- Santa Clara County Public Health Department, San Jose, California, USA (A. Ky)
- Orange County Health Care Agency, Santa Ana, California, USA (Q. Nguyen, J. Low)
| | - Julie Higashi
- California Department of Public Health, Richmond, California, USA (E. Han, S.A. Nabity, H. Henry, M. Cilnis, S. Jain, P.M. Barry, J. Flood)
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S.A. Nabity, M. Moore)
- Los Angeles County Department of Public Health, Los Angeles, California, USA (S. Dasgupta-Tsinikas, R.E. Guevara, J. Higashi)
- San Diego County Health and Human Services Agency, San Diego, California, USA (M. Moore, A. Kadakia)
- Alameda County Public Health Department, San Leandro, California, USA (S. Buhain, A. Chitnis)
- Sacramento County Health Services, Sacramento, California, USA (M. Chakrabarty)
- Santa Clara County Public Health Department, San Jose, California, USA (A. Ky)
- Orange County Health Care Agency, Santa Ana, California, USA (Q. Nguyen, J. Low)
| | - Pennan M. Barry
- California Department of Public Health, Richmond, California, USA (E. Han, S.A. Nabity, H. Henry, M. Cilnis, S. Jain, P.M. Barry, J. Flood)
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S.A. Nabity, M. Moore)
- Los Angeles County Department of Public Health, Los Angeles, California, USA (S. Dasgupta-Tsinikas, R.E. Guevara, J. Higashi)
- San Diego County Health and Human Services Agency, San Diego, California, USA (M. Moore, A. Kadakia)
- Alameda County Public Health Department, San Leandro, California, USA (S. Buhain, A. Chitnis)
- Sacramento County Health Services, Sacramento, California, USA (M. Chakrabarty)
- Santa Clara County Public Health Department, San Jose, California, USA (A. Ky)
- Orange County Health Care Agency, Santa Ana, California, USA (Q. Nguyen, J. Low)
| | - Jennifer Flood
- California Department of Public Health, Richmond, California, USA (E. Han, S.A. Nabity, H. Henry, M. Cilnis, S. Jain, P.M. Barry, J. Flood)
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S.A. Nabity, M. Moore)
- Los Angeles County Department of Public Health, Los Angeles, California, USA (S. Dasgupta-Tsinikas, R.E. Guevara, J. Higashi)
- San Diego County Health and Human Services Agency, San Diego, California, USA (M. Moore, A. Kadakia)
- Alameda County Public Health Department, San Leandro, California, USA (S. Buhain, A. Chitnis)
- Sacramento County Health Services, Sacramento, California, USA (M. Chakrabarty)
- Santa Clara County Public Health Department, San Jose, California, USA (A. Ky)
- Orange County Health Care Agency, Santa Ana, California, USA (Q. Nguyen, J. Low)
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26
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Sempere L, Bernabeu P, Cameo J, Gutiérrez A, García MG, García MF, Aguas M, Belén O, Zapater P, Jover R, van-der Hofstadt C, Ruiz-Cantero MT. Gender Biases and Diagnostic Delay in Inflammatory Bowel Disease: Multicenter Observational Study. Inflamm Bowel Dis 2023; 29:1886-1894. [PMID: 36719111 PMCID: PMC10697413 DOI: 10.1093/ibd/izad001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Female gender could be a cause of diagnostic delay in inflammatory bowel disease (IBD). The aim of this study was to investigate the diagnostic delay in women vs men and potential causes. METHODS This multicenter cohort study included 190 patients with recent diagnosis of IBD (disease duration <7 months). Reconstruction of the clinical presentation and diagnostic process was carried out in conjunction with the semistructured patient interview, review, and electronic medical records. RESULTS The median time from symptom onset to IBD diagnosis was longer in women than in men: 12.6 (interquartile range, 3.7-31) vs 4.5 (2.2-9.8) months for Crohn's disease (CD; P = .008) and 6.1 (3-11.2) vs 2.7 (1.5-5.6) months for ulcerative colitis (UC; P = .008). Sex was an independent variable related to the time to IBD diagnosis in Cox regression analysis. The clinical presentation of IBD was similar in both sexes. Women had a higher percentage of misdiagnosis than men (CD, odds ratio [OR], 3.9; 95% confidence [CI], 1.5-9.9; UC, OR 3.0; 95% CI, 1.2-7.4). Gender inequities in misdiagnosis were found at all levels of the health system (emergency department, OR 2.4; 95% CI, 1.1-5.1; primary care, OR 2.5; 95% CI, 1.3-4.7; gastroenterology secondary care, OR 3.2; 95% CI, 1.2-8.4; and hospital admission, OR 4.3; 95% CI, 1.1-16.9). CONCLUSIONS There is a longer diagnostic delay in women than in men for both CD and UC due to a drawn-out evaluation of women, with a higher number of misdiagnoses at all levels of the health care system.
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Affiliation(s)
- Laura Sempere
- Gastroenterology Department, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Purificación Bernabeu
- Health Psychology Department, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - José Cameo
- Gastroenterology Department, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Ana Gutiérrez
- Gastroenterology Department, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | | | - Mariana Fe García
- Gastroenterology Department, General University Hospital-Elche, Elche, Spain
| | - Mariam Aguas
- Gastroenterology Department, University and Polytechnic La Fe Hospital, Valencia, Spain
| | - Olivia Belén
- Gastroenterology Department, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Pedro Zapater
- Clinical Pharmachology Department, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Rodrigo Jover
- Gastroenterology Department, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Carlos van-der Hofstadt
- Health Psychology Department, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - María Teresa Ruiz-Cantero
- Public Health Department, University of Alicante, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
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27
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Andreasi V, Partelli S, Muffatti F, Battistella A, Fermi F, Balzano G, Crippa S, Tamburrino D, Pecorelli N, De Cobelli F, Arcidiacono PG, Falconi M. Diagnostic work-up and surgical management of insulinoma: A retrospective analysis from a tertiary referral center. J Neuroendocrinol 2023; 35:e13353. [PMID: 37915303 DOI: 10.1111/jne.13353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 06/05/2023] [Accepted: 09/11/2023] [Indexed: 11/03/2023]
Abstract
Insulinoma is a multifaceted disease that poses several challenges in terms of clinical presentation, diagnostic work-up, and surgical management. The aim of this study was to describe diagnostic work-up, surgical management, and postoperative outcomes of patients with insulinoma. All consecutive patients who underwent surgery for insulinoma at San Raffaele Hospital (Milan, Italy) between January 2008 and January 2022 were included. Overall, 98 patients were considered. The median delay between presenting symptoms and insulinoma diagnosis was 10 months (IQR, 4-21). Insulinoma diagnosis was made at our Institution in 45 patients, 20 of whom referred within 6 months from symptoms onset. In this subgroup, the median interval between symptoms presentation and insulinoma diagnosis was 4 months (IQR, 2-6), as compared to 14 months (IQR, 10-26) in patients (n = 25) who referred to our institution after 6 months from symptoms onset (p < .001). The insulinoma was localized preoperatively in all the cases. All patients underwent ≥1 high-quality imaging: computed tomography (CT: n = 87, sensitivity 84%), magnetic resonance imaging (MRI: n = 55, sensitivity 85%) and endoscopic ultrasound (EUS: n = 79, sensitivity 100%). MRI identified the tumor in eight patients with negative CT. EUS localized the insulinoma in three patients with negative CT and negative MRI. Parenchyma-sparing resections were performed in 41 patients. Contact with major vessels, lesion close to Wirsung duct and suspect of malignancy were the main reasons to perform a formal resection. An early referral to high-volume centers is important for reducing diagnostic delay in patients with insulinoma. The diagnostic work-up of insulinoma frequently requires several imaging modalities to be performed, with EUS being the most sensitive one. Parenchyma-sparing surgery for insulinoma should be performed whenever technically and oncologically feasible.
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Affiliation(s)
- Valentina Andreasi
- Pancreatic Surgery Unit, Pancreas Translational and Clinical Research Center, San Raffaele Hospital Neuroendocrine Tumor Group (ENETS Center of Excellence), IRCCS San Raffaele Hospital, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Stefano Partelli
- Pancreatic Surgery Unit, Pancreas Translational and Clinical Research Center, San Raffaele Hospital Neuroendocrine Tumor Group (ENETS Center of Excellence), IRCCS San Raffaele Hospital, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Francesca Muffatti
- Pancreatic Surgery Unit, Pancreas Translational and Clinical Research Center, San Raffaele Hospital Neuroendocrine Tumor Group (ENETS Center of Excellence), IRCCS San Raffaele Hospital, Milan, Italy
| | - Anna Battistella
- Pancreatic Surgery Unit, Pancreas Translational and Clinical Research Center, San Raffaele Hospital Neuroendocrine Tumor Group (ENETS Center of Excellence), IRCCS San Raffaele Hospital, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Francesca Fermi
- Pancreatic Surgery Unit, Pancreas Translational and Clinical Research Center, San Raffaele Hospital Neuroendocrine Tumor Group (ENETS Center of Excellence), IRCCS San Raffaele Hospital, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Gianpaolo Balzano
- Pancreatic Surgery Unit, Pancreas Translational and Clinical Research Center, San Raffaele Hospital Neuroendocrine Tumor Group (ENETS Center of Excellence), IRCCS San Raffaele Hospital, Milan, Italy
| | - Stefano Crippa
- Pancreatic Surgery Unit, Pancreas Translational and Clinical Research Center, San Raffaele Hospital Neuroendocrine Tumor Group (ENETS Center of Excellence), IRCCS San Raffaele Hospital, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Domenico Tamburrino
- Pancreatic Surgery Unit, Pancreas Translational and Clinical Research Center, San Raffaele Hospital Neuroendocrine Tumor Group (ENETS Center of Excellence), IRCCS San Raffaele Hospital, Milan, Italy
| | - Nicolò Pecorelli
- Pancreatic Surgery Unit, Pancreas Translational and Clinical Research Center, San Raffaele Hospital Neuroendocrine Tumor Group (ENETS Center of Excellence), IRCCS San Raffaele Hospital, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco De Cobelli
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Department of Radiology & Center for Experimental Imaging, IRCCS San Raffaele Hospital, Milan, Italy
| | - Paolo Giorgio Arcidiacono
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Pancreato-Biliary Endoscopy and Endosonography Division, IRCCS San Raffaele Hospital, Milan, Italy
| | - Massimo Falconi
- Pancreatic Surgery Unit, Pancreas Translational and Clinical Research Center, San Raffaele Hospital Neuroendocrine Tumor Group (ENETS Center of Excellence), IRCCS San Raffaele Hospital, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
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28
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Vijjhalwar R, Song K, Shrestha R, Bowcock S, Sanchez-Santos MT, Ramasamy K, Javaid MK. Patient-reported symptoms and diagnostic journey in Multiple Myeloma. Front Oncol 2023; 13:1282569. [PMID: 38098501 PMCID: PMC10720586 DOI: 10.3389/fonc.2023.1282569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 11/13/2023] [Indexed: 12/17/2023] Open
Abstract
Introduction Late presentation of multiple myeloma (MM) heightens the risk of complication risks, including end-organ damage. This study aimed to: 1) detail the diagnostic journey of MM patients, encompassing symptoms, initial diagnoses, and healthcare professionals met; 2) establish the median duration from symptom onset to MM diagnosis; and 3) examine factors linked to timely MM diagnosis within 12 weeks. Methods A total of 300 adults self-reporting MM were analysed from the Rare and Undiagnosed Diseases cohort Study (RUDY). The RUDY study is a web-based platform, where participants provide dynamic consent and self-report their MM diagnosis and information about their diagnostic journey. This includes the estimated date of initial potential first symptoms, descriptions of these symptoms, the healthcare professionals they consulted, and other diagnoses received before the MM diagnosis. Descriptive statistics, combinatorial analyses and logistic regression analyses were used to describe and examine the diagnostic journey of individuals with MM. Results Overall, 52% of the participants reported other diagnoses before MM diagnosis, with musculoskeletal disorders (47.8%), such as osteoporosis, costochondritis, or muscle strains, being the most common. The most prevalent initial reported symptom was back pain/vertebral fractures (47%), followed by chest/shoulder pain, including rib pain and fractures (20%), and fatigue/tiredness (19.7%). 40% of participants were diagnosed by direct referral from primary care to haematology without seeing other healthcare professionals whilst 60% consulted additional specialists before diagnosis. The median time from symptom onset to MM diagnosis was 4 months (IQR 2-10 months, range 0-172). Seeing an Allied Healthcare Professional such as a physiotherapist, chiropractor or an osteopath (OR = 0.25, 95% CI [0.12, 0.47], p <0.001), experiencing infection symptoms (OR = 0.32, 95% CI [0.13, 0.76], p = 0.013), and having chest or shoulder pain (OR = 0.45, 95% CI [0.23, 0.86], p = 0.020) were associated with a lower likelihood of being diagnosed with MM within 12 weeks. Older age (OR = 1.04, 95% CI [1.02, 1.07], p = 0.001) was associated with a higher likelihood of diagnosis within 12 weeks. Discussion Developing resources for allied health professionals may improve early recognition of MM.
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Affiliation(s)
- Rohit Vijjhalwar
- Medical Sciences Division, University of Oxford, Oxford, United Kingdom
| | - Kaiyang Song
- Medical Sciences Division, University of Oxford, Oxford, United Kingdom
| | - Roshi Shrestha
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford, United Kingdom
| | - Stella Bowcock
- Department of Haematology, King's College Hospital NHS Trust, London, United Kingdom
| | - Maria T. Sanchez-Santos
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford, United Kingdom
| | - Karthik Ramasamy
- Department of Clinical Haematology, Oxford University Hospitals, NHS Foundation Trust, Oxford, United Kingdom
| | - Muhammad Kassim Javaid
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford, United Kingdom
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29
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Requadt E, Nahlik AJ, Jacobsen A, Ross WT. Patient experiences of endometriosis diagnosis: A mixed methods approach. BJOG 2023. [PMID: 37961031 DOI: 10.1111/1471-0528.17719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 10/21/2023] [Accepted: 10/26/2023] [Indexed: 11/15/2023]
Abstract
OBJECTIVE To examine patient-described experiences of endometriosis diagnosis. DESIGN Mixed-methods study. SETTING Online patient-led endometriosis support groups. POPULATION OR SAMPLE People with endometriosis aged over 18. METHODS A survey with qualitative and quantitative questions was distributed through online patient-led endometriosis support groups. Descriptive statistics were used to analyse quantitative data, and thematic analysis was used for qualitative responses. Quantitative and qualitative data were triangulated to examine patient experiences of endometriosis diagnosis across age groups. MAIN OUTCOME MEASURES Experiences of endometriosis diagnosis among people with endometriosis. RESULTS A total of 2017 people with endometriosis from 63 countries responded to the questionnaire. Patients experienced an average delay of 3.7 years between symptom onset and first presentation of symptoms to a physician (the care-seeking delay) and an average delay of 5.8 years between first presentation of symptoms to a physician and diagnosis of endometriosis (the healthcare-related delay). Patients experienced an average total diagnostic delay of 9.6 years. Participants aged over 35 at the time of the study reported significantly longer times to receive an endometriosis diagnosis (mean 10.7, 95% confidence interval [CI] 10.2-11.2) compared with participants age 18-24 (6.8, 95% CI 6.1-7.5 years). The qualitative analysis identified the following themes: physicians normalised endometriosis symptoms, patients felt their symptoms were ignored by physicians because they were considered unreliable, and participant character attributes (e.g. age, appearance, weight or physical ability) led to clinician dismissal. CONCLUSIONS People with endometriosis of all age groups reported pervasive negative healthcare experiences during their adolescence. Patients experience delays in seeking care and in receiving a diagnosis once presenting for care.
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Affiliation(s)
- Elise Requadt
- Department of Anthropology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Andrew J Nahlik
- Department of Anthropology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Anna Jacobsen
- Department of Anthropology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Whitney Trotter Ross
- Division of Minimally Invasive Gynecologic Surgery, Washington University in St. Louis, St. Louis, Missouri, USA
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30
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Arcana RI, Crișan-Dabija RA, Caba B, Zamfir AS, Cernomaz TA, Zabara-Antal A, Zabara ML, Arcana Ș, Marcu DT, Trofor A. Speaking of the "Devil": Diagnostic Errors in Interstitial Lung Diseases. J Pers Med 2023; 13:1589. [PMID: 38003904 PMCID: PMC10672616 DOI: 10.3390/jpm13111589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 11/05/2023] [Accepted: 11/08/2023] [Indexed: 11/26/2023] Open
Abstract
Interstitial lung diseases are respiratory diseases, which affect the normal lung parenchyma and can lead to significant pulmonary fibrosis, chronic respiratory failure, pulmonary hypertension, and ultimately death. Reuniting more than 200 entities, interstitial lung diseases pose a significant challenge to the clinician, as they represent rare diseases with vague and insidious respiratory symptoms. As such, there are many diagnostic errors that can appear along the journey of the patient with ILD, which leads to significant delays with implications for the prognosis and the quality of life of the patient.
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Affiliation(s)
- Raluca Ioana Arcana
- Doctoral School of the Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (R.I.A.); (A.Z.-A.); (Ș.A.)
- Clinical Hospital of Pulmonary Diseases, 700115 Iasi, Romania; (R.A.C.-D.); (A.-S.Z.); (D.T.M.); (A.T.)
| | - Radu Adrian Crișan-Dabija
- Clinical Hospital of Pulmonary Diseases, 700115 Iasi, Romania; (R.A.C.-D.); (A.-S.Z.); (D.T.M.); (A.T.)
- Department of Medical Sciences III, Pulmonology, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania;
| | - Bogdan Caba
- Department of Biomedical Sciences, Faculty of Medical Bioengineering, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania
| | - Alexandra-Simona Zamfir
- Clinical Hospital of Pulmonary Diseases, 700115 Iasi, Romania; (R.A.C.-D.); (A.-S.Z.); (D.T.M.); (A.T.)
- Department of Medical Sciences III, Pulmonology, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania;
| | - Tudor Andrei Cernomaz
- Department of Medical Sciences III, Pulmonology, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania;
- Regional Institute of Oncology, 700483 Iasi, Romania
| | - Andreea Zabara-Antal
- Doctoral School of the Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (R.I.A.); (A.Z.-A.); (Ș.A.)
- Clinical Hospital of Pulmonary Diseases, 700115 Iasi, Romania; (R.A.C.-D.); (A.-S.Z.); (D.T.M.); (A.T.)
| | - Mihai Lucian Zabara
- Department of Surgery, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania;
- St. Spiridon Emergency Hospital, Clinic of Surgery (II), 700111 Iasi, Romania
| | - Ștefăniță Arcana
- Doctoral School of the Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (R.I.A.); (A.Z.-A.); (Ș.A.)
| | - Dragoș Traian Marcu
- Clinical Hospital of Pulmonary Diseases, 700115 Iasi, Romania; (R.A.C.-D.); (A.-S.Z.); (D.T.M.); (A.T.)
- Department of Medical Sciences I, Cardiology, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania
| | - Antigona Trofor
- Clinical Hospital of Pulmonary Diseases, 700115 Iasi, Romania; (R.A.C.-D.); (A.-S.Z.); (D.T.M.); (A.T.)
- Department of Medical Sciences III, Pulmonology, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania;
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Dahl C, Petersen I, Ilkjær FV, Westh L, Katzenstein TL, Hansen ABE, Nielsen TL, Larsen CS, Johansen IS, Rasmussen LD. Missed Opportunities to Diagnose Common Variable Immunodeficiency: a Population-Based Case-Control Study Identifying Indicator Diseases for Common Variable Immunodeficiency. J Clin Immunol 2023; 43:2104-2114. [PMID: 37770805 PMCID: PMC10661759 DOI: 10.1007/s10875-023-01590-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 09/19/2023] [Indexed: 09/30/2023]
Abstract
PURPOSE Delayed diagnosis of common variable immunodeficiency (CVID) remains a serious problem. We investigated whether some diseases diagnosed during out-patient visits or admission to hospitals could act as indicator conditions for CVID diagnosis. METHODS In this nested case-control study, we identified 128 cases diagnosed with CVID in Denmark (1999-2013) and 640 age-, gender-, and region-matched controls. We obtained data on diseases diagnosed at hospitals in the five years before CVID diagnosis from The National Hospital Registry. We grouped hospital diagnoses in 33 major disease categories and 210 subcategories. We used conditional logistic regression to calculate the odds ratios (OR) and 95% confidence intervals (CI) to estimate associations between disease exposure and subsequent CVID. RESULTS During the five years preceding a CVID diagnosis, cases had four times as many hospital contacts as the controls (p < 0.001). A diagnosis in 18 major disease categories showed a significant OR for subsequent diagnosis of CVID. The most substantial association with a subsequent CVID diagnosis was a diagnosis of lower respiratory tract infections (OR: 29.9; 95% CI: 14.2-63.2) and lung diseases (35.1; 15.0-82.5). We observed a similar association when we removed the last year before diagnosis from analysis and overall, in the years < 1, ≥ 1-3, and ≥ 3-5 before diagnosis, although the absolute number of exposures was small. Twenty-eight specific diseases displayed an at least 3-fold risk of subsequent CVID diagnosis. CONCLUSION Targeted screening for antibody deficiency in patients diagnosed with specific diseases associated with CVID may lead to earlier CVID diagnosis and treatment and thereby potentially reduced morbidity and mortality.
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Affiliation(s)
- Christina Dahl
- Department of Infectious Diseases, Odense University Hospital, J. B. Winsløws Vej 4, Odense, Denmark.
| | - Inge Petersen
- Department of Infectious Diseases, Odense University Hospital, J. B. Winsløws Vej 4, Odense, Denmark
| | - Frederik V Ilkjær
- Department of Infectious Diseases, Odense University Hospital, J. B. Winsløws Vej 4, Odense, Denmark
| | - Lena Westh
- Department of Infectious Diseases, Aarhus University Hospital, Palle Juul-Jensens Blvd. 99, Aarhus, Denmark
| | - Terese L Katzenstein
- Department of Infectious Diseases, Rigshospitalet, Copenhagen University Hospital, Esther Moellersvej 6, Copenhagen, Denmark
| | - Ann-Brit E Hansen
- Department of Infectious Diseases, Hvidovre Hospital, Copenhagen University Hospital, Kettegaard Allé 30, Copenhagen, Denmark
| | - Thyge L Nielsen
- Department of Pulmonary and Infectious Diseases, North Zealand Hospital, Dyrehavevej 29, Hillerod, Denmark
| | - Carsten S Larsen
- Department of Infectious Diseases, Aarhus University Hospital, Palle Juul-Jensens Blvd. 99, Aarhus, Denmark
- International Center of Immunodeficiency Diseases, Aarhus University Hospital, Palle Juul-Jensens Blvd. 99, Aarhus, Denmark
| | - Isik S Johansen
- Department of Infectious Diseases, Odense University Hospital, J. B. Winsløws Vej 4, Odense, Denmark
| | - Line D Rasmussen
- Department of Infectious Diseases, Odense University Hospital, J. B. Winsløws Vej 4, Odense, Denmark
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Tanaka H, Shimaoka M. Challenges associated with delayed definitive diagnosis among Japanese patients with specific intractable diseases: A cross-sectional study. Intractable Rare Dis Res 2023; 12:213-221. [PMID: 38024587 PMCID: PMC10680161 DOI: 10.5582/irdr.2023.01068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 09/18/2023] [Accepted: 10/15/2023] [Indexed: 12/01/2023] Open
Abstract
This study aimed to determine the challenges that cause a delay in the diagnosis of Japanese patients with specific intractable diseases by means of a survey. We conducted a questionnaire survey involving 424 patients with 12 specific intractable diseases. Pearson's chi-square test was used to examine the relationship between diagnostic delay and each factor. The reasons for the diagnostic delay were analyzed. Pearson's chi-square test showed statistically significant differences in the relationship between the period to definitive diagnosis and period between symptom onset and first hospital visit (p = 0.002), and the period when the patients suspected the disease (p < 0.001). Reasons for diagnostic delay of these patients were patients' time constraints, problem in access to medical institutions, hesitancy in seeking medical attention, and healthcare system issues. Early definitive diagnosis of intractable diseases was hindered by several important issues. The resolution of these issues will require combined societal efforts as well as improvements in the healthcare system. The study revealed the need for improving patients' awareness about their disease, enabling patients to be proactive towards achieving a definitive diagnosis, and making improvements in the healthcare system regarding early diagnosis and care of patients with intractable diseases.
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Affiliation(s)
- Hiroyuki Tanaka
- Graduate School of Health Innovation, Kanagawa University of Human Services, Kawasaki, Kanagawa, Japan
- CMIC Ashfield Co., Ltd., Tokyo, Japan
| | - Mikiko Shimaoka
- Graduate School of Health Innovation, Kanagawa University of Human Services, Kawasaki, Kanagawa, Japan
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Orriëns LB, Eker D, Braakman HMH, Merkus PJFM, Erasmus CE. Recognising symptoms of congenital myasthenic syndromes in children: A guide for paediatricians. Acta Paediatr 2023; 112:2434-2439. [PMID: 37551152 DOI: 10.1111/apa.16945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 08/04/2023] [Accepted: 08/07/2023] [Indexed: 08/09/2023]
Abstract
AIM Congenital myasthenic syndromes (CMS) are a rare and diverse group of treatable neuromuscular transmission disorders. Diagnosis is often substantially delayed. This study aimed to identify common symptoms of CMS in children and their manifestation to aid diagnosis and early intervention. METHODS We performed a retrospective cohort study, including 18 children (median age 13 years, range 9 years 5 months-18 years 0 month) with CMS. Data on CMS symptoms and their manifestation were extracted from patients' charts and supplemented with parental telephone interviews. Descriptive analyses were used to identify common symptoms. RESULTS A median diagnostic delay of 4 years and 7 months (interquartile range: 51 months) was observed. Proximal muscle weakness (100%), ptosis (89%), clumsy gait (82%), difficulty eating solid foods (78%) and recurrent respiratory tract infections (72%) were most common in these patients. Symptoms mostly co-occurred and frequently had a fluctuating character, aggravated by infections or fatigue. CONCLUSION Early referral to diagnose CMS is crucial to enable timely initiation of treatment. Heightened attention to a combination of symptoms related to muscle weakness, rather than individual symptoms, should support paediatricians in flagging these neuromuscular disorders. Medical history taking should be tailored to parents' perceptions, asking questions about recognisable symptoms of muscle weakness.
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Affiliation(s)
- Lynn B Orriëns
- Division of Paediatrics, Department of Paediatric Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Amalia Children's Hospital, Nijmegen, The Netherlands
| | - Dilan Eker
- Division of Paediatrics, Department of Paediatric Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Amalia Children's Hospital, Nijmegen, The Netherlands
| | - Hilde M H Braakman
- Division of Paediatrics, Department of Paediatric Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Amalia Children's Hospital, Nijmegen, The Netherlands
| | - Peter J F M Merkus
- Division of Paediatrics, Department of Paediatric Pulmonology, Radboud University Medical Centre, Amalia Children's Hospital, Nijmegen, The Netherlands
| | - Corrie E Erasmus
- Division of Paediatrics, Department of Paediatric Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Amalia Children's Hospital, Nijmegen, The Netherlands
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Messelink MA, Welsing PMJ, Devercelli G, Marsden JWN, Leavis HL. Clinical Validation of a Primary Antibody Deficiency Screening Algorithm for Primary Care. J Clin Immunol 2023; 43:2022-2032. [PMID: 37715890 PMCID: PMC10660978 DOI: 10.1007/s10875-023-01575-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 08/27/2023] [Indexed: 09/18/2023]
Abstract
PURPOSE The diagnostic delay of primary antibody deficiencies (PADs) is associated with increased morbidity, mortality, and healthcare costs. Therefore, a screening algorithm was previously developed for the early detection of patients at risk of PAD in primary care. We aimed to clinically validate and optimize the PAD screening algorithm by applying it to a primary care database in the Netherlands. METHODS The algorithm was applied to a data set of 61,172 electronic health records (EHRs). Four hundred high-scoring EHRs were screened for exclusion criteria, and remaining patients were invited for serum immunoglobulin analysis and referred if clinically necessary. RESULTS Of the 104 patients eligible for inclusion, 16 were referred by their general practitioner for suspected PAD, of whom 10 had a PAD diagnosis. In patients selected by the screening algorithm and included for laboratory analysis, prevalence of PAD was ~ 1:10 versus 1:1700-1:25,000 in the general population. To optimize efficiency of the screening process, we refitted the algorithm with the subset of high-risk patients, which improved the area under the curve-receiver operating characteristics curve value to 0.80 (95% confidence interval 0.63-0.97). We propose a two-step screening process, first applying the original algorithm to distinguish high-risk from low-risk patients, then applying the optimized algorithm to select high-risk patients for serum immunoglobulin analysis. CONCLUSION Using the screening algorithm, we were able to identify 10 new PAD patients from a primary care population, thus reducing diagnostic delay. Future studies should address further validation in other populations and full cost-effectiveness analyses. REGISTRATION Clinicaltrials.gov record number NCT05310604, first submitted 25 March 2022.
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Affiliation(s)
- Marianne A Messelink
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, Netherlands.
| | - Paco M J Welsing
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, Netherlands
| | | | - Jan Willem N Marsden
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Helen L Leavis
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, Netherlands
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Ilkjær FV, Johansen IS, Martin-Iguacel R, Westh L, Katzenstein TL, Hansen ABE, Nielsen TL, Larsen CS, Rasmussen LD. Evaluating Drug Prescription Patterns in Undiagnosed Common Variable Immunodeficiency Patients. J Clin Immunol 2023; 43:2181-2191. [PMID: 37833619 DOI: 10.1007/s10875-023-01598-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 09/29/2023] [Indexed: 10/15/2023]
Abstract
OBJECTIVE To compare the consumption of antibiotics (AB), systemic steroids, and inhaled bronchodilators/glucocorticoids in the 3 years preceding the diagnosis of common variable immunodeficiency (CVID) among CVID patients and matched controls and to estimate whether the level of consumption was associated with the risk of a subsequent CVID diagnosis. METHODS We conducted a nested case-control study, identifying all individuals (n=130 cases) diagnosed with CVID in Denmark (1994-2014) and 45 age- and sex-matched population controls per case (n=5850 controls) from national registers. Drug consumption was estimated as defined daily doses per person-year. We used conditional logistic regression to compute odds ratios and 95% confidence intervals. RESULTS In the 3 years preceding a CVID diagnosis, we observed more frequent and higher consumption of all three drug classes. The association between consumption and risk of subsequent CVID diagnosis was statistically significant for all drug classes. The association was stronger with higher consumption and shorter time to CVID diagnosis. The fraction of cases compared to the controls redeeming ≥1 prescription of the included drugs during the study period was higher for AB (97% vs 52%), systemic steroids (35% vs 7.4%), and inhaled bronchodilators/glucocorticoids (46% vs 11.7%) (p<0.001). CONCLUSION CVID patients have significantly higher use of AB, systemic steroids, and inhaled bronchodilators/glucocorticoids in the 3 years preceding CVID diagnosis than controls. Prescribing these drugs in primary healthcare could be an opportunity to consider (proactive) screening for CVID. Further studies are needed to identify optimal prescription cutoffs that could endorse its inclusion in public health policies.
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Affiliation(s)
- Frederik V Ilkjær
- Department of Infectious Diseases, Odense University Hospital, J.B. Winsløws Vej 4, Odense, Denmark.
- Department of Internal Medicine, Aalborg University Hospital, Højtoftevej 2, Thisted, Denmark.
| | - Isik S Johansen
- Department of Infectious Diseases, Odense University Hospital, J.B. Winsløws Vej 4, Odense, Denmark
| | - Raquel Martin-Iguacel
- Department of Infectious Diseases, Odense University Hospital, J.B. Winsløws Vej 4, Odense, Denmark
| | - Lena Westh
- Department of Infectious Diseases, Aarhus University Hospital, Palle Juul-Jensens Blvd. 99, Aarhus, Denmark
| | - Terese L Katzenstein
- Department of Infectious Diseases, Rigshospitalet, Copenhagen University Hospital, Esther Moellersvej 6, Copenhagen, Denmark
| | - Ann-Brit E Hansen
- Department of Infectious Diseases, Hvidovre Hospital, Copenhagen University Hospital, Kettegaard Allé 30, Copenhagen, Denmark
| | - Thyge L Nielsen
- Department of Pulmonary and Infectious Diseases, North Zealand Hospital, Dyrehavevej 29, Hilleroed, Denmark
| | - Carsten S Larsen
- Department of Infectious Diseases, Aarhus University Hospital, Palle Juul-Jensens Blvd. 99, Aarhus, Denmark
- International Center of Immunodeficiency Diseases, Aarhus University Hospital, Palle Juul-Jensens Blvd. 99, Aarhus, Denmark
| | - Line D Rasmussen
- Department of Infectious Diseases, Odense University Hospital, J.B. Winsløws Vej 4, Odense, Denmark
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Cantoro L, Monterubbianesi R, Falasco G, Camastra C, Pantanella P, Allocca M, Cosintino R, Faggiani R, Danese S, Fiorino G. The Earlier You Find, the Better You Treat: Red Flags for Early Diagnosis of Inflammatory Bowel Disease. Diagnostics (Basel) 2023; 13:3183. [PMID: 37892004 PMCID: PMC10605540 DOI: 10.3390/diagnostics13203183] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 10/09/2023] [Accepted: 10/09/2023] [Indexed: 10/29/2023] Open
Abstract
Delayed diagnosis is a challenge in the management of inflammatory bowel disease (IBD). Several studies show a significant association between diagnostic delay and disease progression to complications and surgery, especially in Crohn's disease (CD). What risk factors are associated with diagnostic delay in IBD remains unclear. In order to reduce diagnostic delay, the Red Flags Index has been developed and validated. The combination of the Red Flags Index score and non-invasive biomarkers such as fecal calprotectin seems to be highly accurate in screening patients with underlying IBD to be referred for further diagnostic workup and eventual early effective treatment strategies. Our literature review aims to obtain a comprehensive overview of the impacts of diagnostic delay in IBD on the potential risk factors associated with IBD, how diagnostic tools may be effective in reducing diagnostic delay, and future perspectives in this field.
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Affiliation(s)
- Laura Cantoro
- IBD Unit, Department of Gastroenterology and Digestive Endoscopy, San Camillo-Forlanini Hospital, 00152 Rome, Italy; (L.C.); (G.F.)
| | - Rita Monterubbianesi
- IBD Unit, Department of Gastroenterology and Digestive Endoscopy, San Camillo-Forlanini Hospital, 00152 Rome, Italy; (L.C.); (G.F.)
| | - Giuliano Falasco
- IBD Unit, Department of Gastroenterology and Digestive Endoscopy, San Camillo-Forlanini Hospital, 00152 Rome, Italy; (L.C.); (G.F.)
| | - Caterina Camastra
- IBD Unit, Department of Gastroenterology and Digestive Endoscopy, San Camillo-Forlanini Hospital, 00152 Rome, Italy; (L.C.); (G.F.)
| | - Paolo Pantanella
- IBD Unit, Department of Gastroenterology and Digestive Endoscopy, San Camillo-Forlanini Hospital, 00152 Rome, Italy; (L.C.); (G.F.)
| | - Mariangela Allocca
- Department of Gastroenterology and Digestive Endoscopy and Vita-Salute San Raffaele University, 20132 Milan, Italy; (M.A.); (S.D.)
| | - Rocco Cosintino
- IBD Unit, Department of Gastroenterology and Digestive Endoscopy, San Camillo-Forlanini Hospital, 00152 Rome, Italy; (L.C.); (G.F.)
| | - Roberto Faggiani
- IBD Unit, Department of Gastroenterology and Digestive Endoscopy, San Camillo-Forlanini Hospital, 00152 Rome, Italy; (L.C.); (G.F.)
| | - Silvio Danese
- Department of Gastroenterology and Digestive Endoscopy and Vita-Salute San Raffaele University, 20132 Milan, Italy; (M.A.); (S.D.)
| | - Gionata Fiorino
- IBD Unit, Department of Gastroenterology and Digestive Endoscopy, San Camillo-Forlanini Hospital, 00152 Rome, Italy; (L.C.); (G.F.)
- Department of Gastroenterology and Digestive Endoscopy and Vita-Salute San Raffaele University, 20132 Milan, Italy; (M.A.); (S.D.)
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Melgaard A, Vestergaard CH, Kesmodel US, Risør BW, Forman A, Zondervan K, Bech BH, Rytter D. Utilization of healthcare prior to endometriosis diagnosis: a Danish case-control study. Hum Reprod 2023; 38:1910-1917. [PMID: 37581901 PMCID: PMC10546074 DOI: 10.1093/humrep/dead164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 08/01/2023] [Indexed: 08/16/2023] Open
Abstract
STUDY QUESTION Do women with endometriosis have higher utilization of primary and secondary healthcare prior to diagnosis compared to women without endometriosis? SUMMARY ANSWER Women with a hospital-based diagnosis of endometriosis had an overall higher utilization of both primary and secondary healthcare in all 10 years prior to diagnosis. WHAT IS KNOWN ALREADY Endometriosis is associated with a diagnostic delay, but only a few studies have investigated the potential consequences of this delay with regard to the utilization of healthcare. To the best of our knowledge, no study has investigated it in a period corresponding to the estimated diagnostic delay. STUDY DESIGN, SIZE, DURATION This national Danish registry-based case-control study included 129 696 women. Cases were women with a first-time hospital-based diagnosis of endometriosis between 1 January 2000 and 31 December 2017. PARTICIPANTS/MATERIALS, SETTING, METHODS We identified 21 616 cases using density sampling. Each case was matched on age at the date of diagnosis (index date) to five women without diagnosed endometriosis (n = 108 080). The utilization of healthcare was assessed for the 10 years before the index. MAIN RESULTS AND THE ROLE OF CHANCE Cases had significantly higher use of healthcare in all 10 years preceding the index. The mean number of yearly contacts with the GP was 9.99 for cases and 7.85 for controls, with an adjusted incidence rate ratio of 1.28 (1.27; 1.29). For hospital contacts, the association increased slightly in the first 9 years and was most profound in the last year preceding index when the adjusted incidence rate ratio was 2.26 (95% CI 2.28; 2.31). LIMITATIONS, REASONS FOR CAUTION We were not able to include women with an endometriosis diagnosis from the general practitioner or private gynaecologist. Therefore, our results are only applicable to hospital-based diagnoses of endometriosis. We do not have information on the specific reasons for contacting the healthcare providers and we can therefore only speculate that the higher utilization of healthcare among cases was related to endometriosis. WIDER IMPLICATIONS OF THE FINDINGS This study is in agreement with the other known studies on the subject. Future studies should include specific reasons for contacting the healthcare system and thereby identify any specific contact patterns for women with endometriosis. With this knowledge, healthcare professionals could be better at relating certain healthcare seeking behaviour to endometriosis earlier and thereby reduce the time from onset of symptoms to diagnosis. STUDY FUNDING/COMPETING INTEREST(S) This study is supported by grants from the project 'Finding Endometriosis using Machine Learning' (FEMaLe/101017562), which has received funding from The European Union's Horizon 2020 research and innovation program and Helsefonden (21-B-0141). K.Z. report grants from Bayer AG, Roche Inc. and Volition, royalties from Oxford-Bayer scientific collaboration in gynaecological therapies, non-financial collaboration with the World Endometriosis Society and World Endometriosis Research Foundation and is a Wellbeing of Women research advisory committee member. All this is outside the submitted work. The other authors have no conflict of interest to declare. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Anna Melgaard
- Department of Public Health, Research Unit of Epidemiology, Aarhus University, Aarhus C, Denmark
| | - Claus Høstrup Vestergaard
- Department of Public Health, Research Unit for General Practice, Aarhus University, Aarhus C, Denmark
| | | | - Bettina Wulff Risør
- DEFACTUM, Central Denmark Region, Aarhus N, Denmark
- Department of Clinical Medicine, Danish Centre for Health Services Research, Aalborg University, Gistrup, Denmark
| | - Axel Forman
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus N, Denmark
| | - Krina Zondervan
- Nuffield Department of Women’s and Reproductive Health, John Radcliffe Hospital, Oxford University, Oxford, UK
| | - Bodil Hammer Bech
- Department of Public Health, Research Unit of Epidemiology, Aarhus University, Aarhus C, Denmark
| | - Dorte Rytter
- Department of Public Health, Research Unit of Epidemiology, Aarhus University, Aarhus C, Denmark
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Tamura H, Uehara T, Li Y, Yamasaki K, Ikusaka M. A Stepwise Progression of Acute Bilateral Visual Loss Due to Onodi Cell Sinusitis. Cureus 2023; 15:e47359. [PMID: 38021640 PMCID: PMC10657452 DOI: 10.7759/cureus.47359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2023] [Indexed: 12/01/2023] Open
Abstract
Acute visual loss in an immunocompromised patient may be caused by acute invasive fungal sinusitis (AIFS), even if symptoms include only mild headache and computed tomography (CT) shows only mild sinusitis, especially of the Onodi cell. Herein, we report a case of a 71-year-old man with a medical history of dermatomyositis and type 2 diabetes mellitus who presented with a stepwise progression of acute bilateral visual loss, mild headache, and altered consciousness. Initially, as the plain cranial CT showed only mild fluid retention in the posterior ethmoid sinus without bone destruction, the sinusitis was considered unrelated to the visual loss. Afterward, however, contrast-enhanced cranial magnetic resonance imaging (MRI) showed mucosal thickening, fluid retention in the posterior ethmoid sinus, and spread of the contrast medium over the dura around the right posterior ethmoid sinus and bilateral optic nerve tracts. Aspergillus fumigatus was identified from endoscopic drainage of the sinus. The patient was diagnosed with AIFS and treated with amphotericin B 350 mg/day. The altered sensorium and headache rapidly improved, and his left visual acuity improved to counting fingers. Although AIFS is rare, it can cause severe sequela or death due to vascular or direct intracranial invasion. Therefore, immediate drainage of the sinus and intravenous antifungal therapy are essential for AIFS. Our findings will help physicians make accurate and rapid diagnoses of AIFS in future cases.
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Affiliation(s)
- Hiroki Tamura
- General Medicine, Chiba University Hospital, Chiba, JPN
| | | | - Yu Li
- General Medicine, Chiba University Hospital, Chiba, JPN
| | - Kazuki Yamasaki
- Otorhinolaryngology - Head and Neck Surgery, Chiba University Hospital, Chiba, JPN
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Petruzzi M, Della Vella F, Squicciarini N, Lilli D, Campus G, Piazzolla G, Lucchese A, van der Waal I. Diagnostic delay in autoimmune oral diseases. Oral Dis 2023; 29:2614-2623. [PMID: 36565434 DOI: 10.1111/odi.14480] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 09/27/2022] [Accepted: 12/20/2022] [Indexed: 12/25/2022]
Abstract
Autoimmune diseases (ADs) affect about 5% of the general population, causing various systemic and/or topical clinical manifestations. The oral mucosa is often affected, sometimes as the only involved site. The misdiagnosis of oral ADs is an underreported issue. This narrative review focuses on diagnostic delay (DD) in oral ADs (oral lichen planus [OLP], oral Pemphigus Vulgaris, mucous membrane pemphigoid, oral lupus erythematosus, orofacial granulomatosis, oral erythema multiforme [EM], and Sjogren syndrome). Extensive literature research was conducted via MEDLINE, Embase and Google Scholar databases for articles reporting the time spent to achieve the correct diagnosis of oral ADs. Only 16 studies reported DD in oral ADs. Oral autoimmune vesiculobullous diseases are usually diagnosed after 8 months from the initial signs/symptoms, the Sjogren Syndrome diagnosis usually requires about 73 months. No data exist about the DD in OLP, oral lupus erythematosus, orofacial granulomatosis, and oral EM. The diagnosis of oral ADs can be difficult due to the non-specificity of their manifestations and the unawareness of dentists, physicians, and dental and medical specialists about these diseases. This can lead to a professional DD and a consequential treatment delay. The delay can be attributed to the physicians or/and the healthcare system (Professional Delay) or the patient (Patient's Delay).
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Affiliation(s)
- Massimo Petruzzi
- Interdisciplinary Department of Medicine, University of Bari "Aldo Moro", Bari, Italy
- Department of Restorative, Preventive and Pediatric Dentistry, University of Bern, Bern, Switzerland
| | - Fedora Della Vella
- Interdisciplinary Department of Medicine, University of Bari "Aldo Moro", Bari, Italy
| | - Nicola Squicciarini
- Interdisciplinary Department of Medicine, University of Bari "Aldo Moro", Bari, Italy
| | - Davide Lilli
- Interdisciplinary Department of Medicine, University of Bari "Aldo Moro", Bari, Italy
| | - Guglielmo Campus
- Department of Restorative, Preventive and Pediatric Dentistry, University of Bern, Bern, Switzerland
- Department of Surgery, Microsurgery and Medicine Sciences, School of Dentistry, University of Sassari, Sassari, Italy
- School of Dentistry, Sechenov University, Moscow, Russia
| | - Giuseppina Piazzolla
- Interdisciplinary Department of Medicine, Section of Internal Medicine "G. Baccelli", University of Bari "Aldo Moro", Bari, Italy
| | - Alberta Lucchese
- Multidisciplinary Department of Medical and Dental Specialties, University of Campania-Luigi Vanvitelli, Naples, Italy
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Moore CE, Marshall L. Diagnosing Extrapulmonary Sarcoidosis and the Implications of Diagnosis on Military Service. Cureus 2023; 15:e47115. [PMID: 38021643 PMCID: PMC10647944 DOI: 10.7759/cureus.47115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2023] [Indexed: 12/01/2023] Open
Abstract
Sarcoidosis is a systemic inflammatory disease that can cause granulomatous infiltration of almost all organs and tissues which allows for a wide variety of presentations that may overlap with other disease processes. Renal sarcoidosis is a much rarer site of extrapulmonary involvement and may present as hypercalcemia, tubular or glomerular dysfunction, and/or granulomatous interstitial nephritis. Prompt diagnosis of sarcoidosis is crucial for initiating appropriate treatment and avoiding organ dysfunction. Herein, we describe a case of an armed forces service member who developed extrapulmonary sarcoidosis and renal sarcoidosis with acute complications refractory to glucocorticoids requiring adalimumab. The case highlights and emphasizes a rare manifestation of extrapulmonary sarcoidosis, the importance of avoiding premature closure of the differential diagnosis to avoid diagnostic delay and treatment imitation, and the unique clinical reasoning that occurs in active-duty personnel where diagnoses and subsequent treatments can have career implications and affect the ability of the service member to maintain the ability to deploy worldwide.
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Affiliation(s)
- Caroline E Moore
- Internal Medicine, Naval Medical Center San Diego, San Diego, USA
| | - Landry Marshall
- Internal Medicine, Naval Medical Center Camp Lejeune, Camp Lejeune, USA
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Matsumoto T, Imai K, Goda Y, Fujimitsu Y, Kajioka T, Kihara H, Funaki Y, Imaki S, Ueno M. Questionnaire Survey for Inflammatory Bowel Disease Patients in Japan; A Web-Based Japan, Crohn's Disease, Ulcerative Colitis, Patients Survey. Crohns Colitis 360 2023; 5:otad069. [PMID: 38028953 PMCID: PMC10676197 DOI: 10.1093/crocol/otad069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Indexed: 12/01/2023] Open
Abstract
Background/Aims The prevalence of inflammatory bowel disease (IBD) in Japan has been increasing. We aimed to clarify the symptoms of patients with IBD in Japan using an internet-based questionnaire survey. Methods Overall, 805 patients with IBD were asked to complete an internet-based questionnaire addressing their history of disturbances in daily activities, prevalence of fecal urgency, incontinence, and treatment preferences. Results Responses were obtained from 447 patients with IBD (mean age: 54 years; 70% were men), comprising 363 patients with ulcerative colitis (UC), and 84 with Crohn's disease (CD). Notably, 16% of patients with UC and 35% with CD took over 1 year until the diagnosis of IBD, and 5% of patients with CD visited more than 5 medical institutions. Patients with CD were more likely to experience disturbances in their diet, work, travel, and outings than those with UC. Fecal urgency and incontinence were significantly more frequent in patients with CD than in those with UC (72% vs. 44%, and 50% vs. 26%, respectively). In contrast, 26% of the men and 37% of women with IBD had constipation. Acid reflux, sleep disorders, and depressive symptoms were present in approximately 30% of the patients. Oral administration was preferred. Conclusions Patients with IBD in Japan experience more severe disturbances in their daily activities, and these are more severe in those with CD than those with UC. In addition to fecal urgency and incontinence, care is required for constipation, acid reflux, sleep disorders, and depressive symptoms.
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Affiliation(s)
- Takayuki Matsumoto
- Division of Gastroenterology, Department of Internal Medicine, School of Medicine, Iwate Medical University, Iwate, Japan
| | - Keita Imai
- Department of IBD Strategy, EA Pharma Co., Ltd., Tokyo, Japan
| | - Yuki Goda
- Department of IBD Strategy, EA Pharma Co., Ltd., Tokyo, Japan
| | - Yuki Fujimitsu
- Department of IBD Strategy, EA Pharma Co., Ltd., Tokyo, Japan
| | | | - Hideaki Kihara
- Department of IBD Strategy, EA Pharma Co., Ltd., Tokyo, Japan
| | - Yuji Funaki
- Department of Integrated Marketing, EA Pharma Co., Ltd., Tokyo, Japan
| | - Shigeru Imaki
- Department of Corporate Communication, EA Pharma Co., Ltd., Tokyo, Japan
| | - Masato Ueno
- Department of IBD Strategy, EA Pharma Co., Ltd., Tokyo, Japan
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Shinden Y, Kamimura K, Hayashi N, Nomoto Y, Nagata A, Eguchi Y, Yano H, Saho H, Nakajo A, Minami K, Hirashima T, Sasaki K, Yoshinaka H, Owaki T, Tanimoto A, Nakamura M, Otsuka T. Relationship between Delayed Breast Cancer Diagnosis and Behavioral Economic Factors and Personality Characteristics. Asian Pac J Cancer Prev 2023; 24:3437-3440. [PMID: 37898848 PMCID: PMC10770666 DOI: 10.31557/apjcp.2023.24.10.3437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Indexed: 10/30/2023] Open
Abstract
BACKGROUND Delays in breast cancer diagnosis can allow the disease to progress to an incurable stage. However, factors that cause patients to delay seeking treatment are unclear. In this study, we aimed to identify behavioral economic factors and personality characteristics of patients with breast cancer who had a delayed diagnosis. METHODS We analyzed questionnaires completed by 41 patients with breast cancer. A delayed diagnosis was defined if the time between the first symptom and the medical visit was more than 6 months. RESULTS We found 11 patients who had a delayed diagnosis. The significant characteristics associated with patients with breast cancer who had delayed diagnosis were: (i) less experience with breast cancer screening; (ii) progressive disease stage; and (iii) low time and future time preference. We found no significant behavioral economic factors other than time preference, and personality that differed between patients with breast cancer who did and did not have a delayed diagnosis. CONCLUSION Low time preference rate is a characteristic of patients with breast cancer who had a delayed diagnosis.
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Affiliation(s)
- Yoshiaki Shinden
- Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1, Sakuragaoka, Kagoshima- City, Japan
| | - Kayo Kamimura
- Department of Psychiatry, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1, Sakuragaoka, Kagoshima-City, Japan
| | - Naoki Hayashi
- Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1, Sakuragaoka, Kagoshima- City, Japan
- Department of Breast Surgery, Kagoshima City Hospital, 37-1, Kamiarata, Kagoshima-City, Japan
| | - Yuki Nomoto
- Department of Breast Surgery, Kagoshima City Hospital, 37-1, Kamiarata, Kagoshima-City, Japan
| | - Ayako Nagata
- Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1, Sakuragaoka, Kagoshima- City, Japan
| | - Yuka Eguchi
- Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1, Sakuragaoka, Kagoshima- City, Japan
| | - Hanako Yano
- Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1, Sakuragaoka, Kagoshima- City, Japan
| | - Hazuki Saho
- Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1, Sakuragaoka, Kagoshima- City, Japan
| | - Akihiro Nakajo
- Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1, Sakuragaoka, Kagoshima- City, Japan
| | - Koji Minami
- Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1, Sakuragaoka, Kagoshima- City, Japan
| | - Tadahiro Hirashima
- Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1, Sakuragaoka, Kagoshima- City, Japan
| | - Ken Sasaki
- Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1, Sakuragaoka, Kagoshima- City, Japan
| | - Heiji Yoshinaka
- Department of Breast Surgery, Kagoshima City Hospital, 37-1, Kamiarata, Kagoshima-City, Japan
| | - Tetsuhiro Owaki
- Department of Community-based Medicine Education Center for Doctors in Remote Island and Rural Areas, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1, Sakuragaoka, Kagoshima-City, Japan
| | - Akihide Tanimoto
- Department of Pathology, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1, Sakuragaoka, Kagoshima-City, Japan
- Center for the Research of Advanced Diagnosis and Therapy of Cancer, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima 890-8544, Japan
| | - Masayuki Nakamura
- Department of Psychiatry, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1, Sakuragaoka, Kagoshima-City, Japan
| | - Takao Otsuka
- Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1, Sakuragaoka, Kagoshima- City, Japan
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Chen YH, Drye M, Chen Q, Fecher M, Liu G, Guthrie W. Delay from Screening to Diagnosis in Autism Spectrum Disorder: Results from a Large National Health Research Network. J Pediatr 2023; 260:113514. [PMID: 37244580 PMCID: PMC10805541 DOI: 10.1016/j.jpeds.2023.113514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 03/22/2023] [Accepted: 05/21/2023] [Indexed: 05/29/2023]
Abstract
To examine delay from developmental screening to autism diagnosis, we used real-world health care data from a national research network to estimate the time between these events. We found an average delay of longer than 2 years from first screening to diagnosis, with no significant differences observed by sex, race, or ethnicity.
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Affiliation(s)
- Yu-Hsin Chen
- The Harold and Inge Marcus Department of Industrial and Manufacturing Engineering, The Pennsylvania State University, University Park, PA
| | - Madison Drye
- Center for Autism Research, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Qiushi Chen
- The Harold and Inge Marcus Department of Industrial and Manufacturing Engineering, The Pennsylvania State University, University Park, PA.
| | - Madison Fecher
- Center for Autism Research, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Guodong Liu
- Department of Public Health Sciences, The Pennsylvania State University, Hershey, PA; Department of Psychiatry and Behavioral Health, The Pennsylvania State University, Hershey, PA
| | - Whitney Guthrie
- Center for Autism Research, The Children's Hospital of Philadelphia, Philadelphia, PA; Clinical Futures, The Children's Hospital of Philadelphia, Philadelphia, PA; Department of Psychiatry and Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
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Wang J, Zhen X, Coyte PC, Shao D, Zhao N, Chang L, Feng Y, Sun X. Association Between Online Health Information-Seeking Behaviors by Caregivers and Delays in Pediatric Cancer: Mixed Methods Study in China. J Med Internet Res 2023; 25:e46953. [PMID: 37585244 PMCID: PMC10468701 DOI: 10.2196/46953] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 07/06/2023] [Accepted: 07/19/2023] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND Pediatric cancer patients in China often present at an advanced stage of disease resulting in lower survival and poorer health outcomes. One factor hypothesized to contribute to delays in pediatric cancer has been the online health information-seeking (OHIS) behaviors by caregivers. OBJECTIVE This study aims to examine the association between OHIS behaviors by caregivers and delays for Chinese pediatric cancer patients using a mixed methods approach. METHODS This study used a mixed methods approach, specifically a sequential explanatory design. OHIS behavior by the caregiver was defined as the way caregivers access information relevant to their children's health via the Internet. Delays in pediatric cancer were defined as any one of the following 3 types of delay: patient delay, diagnosis delay, or treatment delay. The quantitative analysis methods included descriptive analyses, Student t tests, Pearson chi-square test, and binary logistic regression analysis, all performed using Stata. The qualitative analysis methods included conceptual content analysis and the Colaizzi method. RESULTS A total of 303 pediatric cancer patient-caregiver dyads was included in the quantitative survey, and 29 caregivers completed the qualitative interview. Quantitative analysis results revealed that nearly one-half (151/303, 49.8%) of patients experienced delays in pediatric cancer, and the primary type of delay was diagnosis delay (113/303, 37.3%), followed by patient delay (50/303, 16.5%) and treatment delay (24/303, 7.9%). In this study, 232 of the 303 (76.6%) caregiver participants demonstrated OHIS behaviors. When those engaged in OHIS behaviors were compared with their counterparts, the likelihood of patient delay more than doubled (odds ratio=2.21; 95% CI 1.03-4.75). Qualitative analysis results showed that caregivers' OHIS behaviors impacted the cancer care pathway by influencing caregivers' symptom appraisal before the first medical contact and caregivers' acceptance of health care providers' diagnostic and treatment decisions. CONCLUSIONS Our findings suggest that OHIS among Chinese pediatric caregivers may be a risk factor for increasing the likelihood of patient delay. Our government and society should make a concerted effort to regulate online health information and improve its quality. Specialized freemium consultations provided by health care providers via online health informatic platforms are needed to shorten the time for caregivers' cancer symptom appraisal before the first medical contact.
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Affiliation(s)
- Jiamin Wang
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- National Health Commission Key Lab of Health Economics and Policy Research, Shandong University, West-Wenhua Road, 44, Jinan, China
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Xuemei Zhen
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- National Health Commission Key Lab of Health Economics and Policy Research, Shandong University, West-Wenhua Road, 44, Jinan, China
| | - Peter C Coyte
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Di Shao
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- National Health Commission Key Lab of Health Economics and Policy Research, Shandong University, West-Wenhua Road, 44, Jinan, China
| | - Ni Zhao
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- National Health Commission Key Lab of Health Economics and Policy Research, Shandong University, West-Wenhua Road, 44, Jinan, China
| | - Lele Chang
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- National Health Commission Key Lab of Health Economics and Policy Research, Shandong University, West-Wenhua Road, 44, Jinan, China
| | - Yujia Feng
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- National Health Commission Key Lab of Health Economics and Policy Research, Shandong University, West-Wenhua Road, 44, Jinan, China
| | - Xiaojie Sun
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- National Health Commission Key Lab of Health Economics and Policy Research, Shandong University, West-Wenhua Road, 44, Jinan, China
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Istamov K, Beglaryan M, Goncharova O, Sakmamatov K, Kyrbashov B, Mamytova M, Zairova I, Alumkylova G, Nair D. Delays in Treatment Initiation and Treatment Outcomes in Patients with Tuberculosis in the Kyrgyz Republic: Are There Differences between Migrants and Non-Migrants? Trop Med Infect Dis 2023; 8:412. [PMID: 37624350 PMCID: PMC10458606 DOI: 10.3390/tropicalmed8080412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 08/08/2023] [Accepted: 08/09/2023] [Indexed: 08/26/2023] Open
Abstract
Migrants are at increased risk of developing tuberculosis (TB) and have poor treatment outcomes. The National TB program (NTP) of the Kyrgyz Republic recognizes two types of migrants: internal (intra-country) and external (inter-country) migrants. This cohort study compared the characteristics, timeliness of diagnosis and treatment initiation, and treatment outcomes of TB patients (internal migrant vs. external migrant vs. non-migrant) identified during treatment in the country in 2021. The TB treatment register and treatment cards of 5114 patients (156 internal, 430 external, and 4528 non-migrants) were reviewed. Risk factors (unemployment, smoking, alcohol use, and homelessness) were higher (p-value < 0.001) in internal (84%) than in external migrants (66%) and non-migrants (43%). The median delay in seeking care post-symptom onset was longer (p-value= 0.03) in external (30 days) than in internal migrants (21 days) and non-migrants (25 days). Successful treatment outcomes for drug-sensitive TB were higher in internal (89%, p-value = 0.012) and external migrants (86%, p-value = 0.001) than in non-migrants (78%). Internal and external migrants should be separately considered with respect to TB care and monitoring under the NTP. Success rates seem to be high in migrants, but our findings may be biased, as migrants with poor healthcare access may remain undetected and untreated and have undocumented poor outcomes.
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Affiliation(s)
- Kylychbek Istamov
- School of Medicine, Osh State University, Osh City 723500, Kyrgyzstan
| | - Mher Beglaryan
- Tuberculosis Research and Prevention Center, Yerevan 0014, Armenia
| | - Olga Goncharova
- National Center for Phthisiology, Bishkek 720000, Kyrgyzstan
| | - Konushbek Sakmamatov
- Faculty of Medicine, Ala-Too International University, Bishkek 720000, Kyrgyzstan
| | - Bolot Kyrbashov
- National Center for Phthisiology, Bishkek 720000, Kyrgyzstan
| | - Mukadas Mamytova
- School of Medicine, Osh State University, Osh City 723500, Kyrgyzstan
| | - Indira Zairova
- School of Medicine, Osh State University, Osh City 723500, Kyrgyzstan
| | | | - Divya Nair
- International Union Against TB and Lung Disease (The Union), 75001 Paris, France
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Arslan N, Coker M, Gokcay GF, Kiykim E, Onenli Mungan HN, Ezgu F. Expert opinion on patient journey, diagnosis and clinical monitoring in acid sphingomyelinase deficiency in Turkey: a pediatric metabolic disease specialist's perspective. Front Pediatr 2023; 11:1113422. [PMID: 37435168 PMCID: PMC10330960 DOI: 10.3389/fped.2023.1113422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 06/06/2023] [Indexed: 07/13/2023] Open
Abstract
This review by a panel of pediatric metabolic disease specialists aimed to provide a practical and implementable guidance document to assist clinicians in best clinical practice in terms of recognition, diagnosis and management of patients with acid sphingomyelinase deficiency (ASMD). The participating experts consider the clinical suspicion of ASMD by the physician to be of utmost importance in the prevention of diagnostic delay and strongly suggest the use of a diagnostic algorithm including/starting with dried blood spots assay in the timely diagnosis of ASMD in patients presenting with hepatosplenomegaly and a need for increased awareness among physicians in this regard to consider ASMD in the differential diagnosis. In anticipation of the introduction of enzyme replacement therapy, raising awareness of the disease among physicians to prevent diagnostic delay and further investigation addressing natural history of ASMD across the disease spectrum, potential presenting characteristics with a high index of suspicion, as well as biomarkers and genotype-phenotype correlations suggestive of poor prognosis seem important in terms of implementation of best practice patterns.
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Affiliation(s)
- Nur Arslan
- Division of Pediatric Metabolism, Department of Pediatrics, Dokuz Eylul University Faculty of Medicine, Izmir, Türkiye
| | - Mahmut Coker
- Division of Pediatric Metabolism, Department of Pediatrics, Ege University Faculty of Medicine, Izmir, Türkiye
| | - Gulden Fatma Gokcay
- Division of Pediatric Metabolism, Department of Pediatrics, Istanbul University Istanbul Faculty of Medicine, Istanbul, Türkiye
| | - Ertugrul Kiykim
- Division of Pediatric Metabolism, Department of Pediatrics, Istanbul University Cerrahpasa Faculty of Medicine, Istanbul, Türkiye
| | | | - Fatih Ezgu
- Division of Pediatric Metabolism and Pediatric Genetics, Department of Pediatrics, Gazi University Faculty of Medicine, Ankara, Türkiye
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Bowcock S, Atkin C, Iqbal G, Pratt G, Yong K, Neal RD, Planche T, Karunanithi K, Jenkins S, Stern S, Arnott S, Toth P, Wandroo F, Dunn J, Drayson MT. Presenting Symptoms in Newly Diagnosed Myeloma, Relation to Organ Damage, and Implications for Symptom-Directed Screening: A Secondary Analysis from the Tackling Early Morbidity and Mortality in Myeloma (TEAMM) Trial. Cancers (Basel) 2023; 15:3337. [PMID: 37444449 PMCID: PMC10341254 DOI: 10.3390/cancers15133337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/26/2023] [Accepted: 06/09/2023] [Indexed: 07/15/2023] Open
Abstract
Multiple myeloma (MM) patients risk diagnostic delays and irreversible organ damage. In those with newly diagnosed myeloma, we explored the presenting symptoms to identify early signals of MM and their relationships to organ damage. The symptoms were recorded in patients' own words at diagnosis and included diagnostic time intervals. Those seen by a haematologist >6 months prior to MM diagnosis were classified as precursor disease (PD). Most (962/977) patients provided data. Back pain (38%), other pain (31%) and systemic symptoms (28%) predominated. Patients rarely complain of 'bone pain', simply 'pain'. Vertebral fractures are under-recognised as pathological and are the predominant irreversible organ damage (27% of patients), impacting the performance status (PS) and associated with back pain (odds ratio (OR) 6.14 [CI 4.47-8.44]), bone disease (OR 3.71 [CI 1.88-7.32]) and age >65 years (OR 1.58 [CI 1.15-2.17]). Renal failure is less frequent and associated with gastrointestinal symptoms (OR 2.23 [CI1.28-3.91]), age >65 years (OR 2.14 [CI1.28-3.91]) and absence of back pain (OR 0.44 [CI 0.29-0.67]). Patients with known PD (n = 149) had fewer vertebral fractures (p = 0.001), fewer adverse features (p = 0.001), less decline in PS (p = 0.001) and a lower stage (p = 0.04) than 813 with de novo MM. Our data suggest subgroups suitable for trials of 'symptom-directed' screening: those with back pain, unexplained pain, a general decline in health or low-impact vertebral compression fractures.
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Affiliation(s)
- Stella Bowcock
- Department of Haematological Medicine, King’s College Hospital NHS Trust, London SE5 9RS, UK
- Princess Royal Hospital, King’s College Hospital NHS Trust, Orpington Common, London BR6 8ND, UK
| | - Catherine Atkin
- Institute of Inflammation and Ageing, University of Birmingham, Edgbaston, Birmingham B15 2GW, UK
| | - Gulnaz Iqbal
- Warwick Clinical Trials Unit, University of Warwick, Coventry CV4 7AL, UK
| | - Guy Pratt
- Queen Elizabeth Hospital, University Hospitals Birmingham NHS Trust, Birmingham B15 2TH, UK
| | - Kwee Yong
- Department of Haematology, UCL Cancer Institute, London NW1 2BU, UK
| | - Richard D. Neal
- Department of Primary Care Medicine, University of Exeter, Exeter EX1 2LU, UK
| | - Tim Planche
- Department of Medical Microbiology, St George’s Hospital NHS Trust, London SW17 0QT, UK
| | - Kamaraj Karunanithi
- Royal Stoke University Hospital, University Hospitals North Midlands NHS Trust, Stoke-on-Trent ST4 6QG, UK
| | - Stephen Jenkins
- Russell Halls Hospital, The Dudley Group NHS Foundation Trust, Dudley DY1 2HQ, UK
| | - Simon Stern
- Epsom and St Helier NHS Trust, London SM5 1AA, UK
| | | | - Peter Toth
- Sheffield Teaching Hospitals NHS Trust, Sheffield S10 2JF, UK
| | - Farooq Wandroo
- Sandwell General Hospital, Lyndon, West Bromwich, West Midlands B71 4HJ, UK
| | - Janet Dunn
- Warwick Clinical Trials Unit, University of Warwick, Coventry CV4 7AL, UK
| | - Mark T. Drayson
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham B15 2TT, UK
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González-Ruiz I, Ramos-García P, Ruiz-Ávila I, González-Moles MÁ. Early Diagnosis of Oral Cancer: A Complex Polyhedral Problem with a Difficult Solution. Cancers (Basel) 2023; 15:3270. [PMID: 37444379 DOI: 10.3390/cancers15133270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 06/16/2023] [Accepted: 06/19/2023] [Indexed: 07/15/2023] Open
Abstract
Oral and oropharyngeal cancers are a growing problem, accounting for 377,713 and 98,412 new cases per year all over the world and 177,757 and 48,143 deaths annually, respectively. Despite the substantial improvement in diagnostic procedures and treatment techniques in recent years, the mortality rate has not decreased substantially in the last 40 years, which is still close to 50% of cases. The major cause responsible for this high mortality is associated with the high percentage of oral cancers diagnosed in advanced stages (stages III and IV) where the treatment harbors poor efficacy, resulting in challenges, mutilations, or disability. The main reason for cancer to be diagnosed at an advanced stage is a diagnostic delay, so it is critical to reduce this delay in order to improve the prognosis of patients suffering from oral cancer. The causes of oral cancer diagnostic delay are complex and concern patients, healthcare professionals, and healthcare services. In this manuscript, oral cancer diagnostic delay is critically reviewed based on current evidence, as well as their major causes, main problems, and potential improvement strategies.
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Affiliation(s)
- Isabel González-Ruiz
- School of Dentistry, University of Granada, 18071 Granada, Spain
- Instituto de Investigación Biosanitaria ibs.GRANADA, 18012 Granada, Spain
| | - Pablo Ramos-García
- School of Dentistry, University of Granada, 18071 Granada, Spain
- Instituto de Investigación Biosanitaria ibs.GRANADA, 18012 Granada, Spain
| | - Isabel Ruiz-Ávila
- Instituto de Investigación Biosanitaria ibs.GRANADA, 18012 Granada, Spain
- Hospital Universitario San Juan de Reus, CAP Marià Fortuny, 43204 Tarragona, Spain
| | - Miguel Ángel González-Moles
- School of Dentistry, University of Granada, 18071 Granada, Spain
- Instituto de Investigación Biosanitaria ibs.GRANADA, 18012 Granada, Spain
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Shahid M, Phan B, Tir V, Engel C, El-Bahri J. Mycotic Aneurysm of the Thoracoabdominal Aorta: A Diagnostic Challenge. Cureus 2023; 15:e40894. [PMID: 37492842 PMCID: PMC10365147 DOI: 10.7759/cureus.40894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2023] [Indexed: 07/27/2023] Open
Abstract
Mycotic aortic aneurysms (MAAs) are a rare form of aortic aneurysms that are associated with catastrophic outcomes if not diagnosed and treated on time. However, MAAs are a diagnostic challenge owing to their often nonspecific presentation. In this study, we present a case of a 42-year-old female with a pertinent history of intravenous drug use who presented with generalized body pain for two weeks and was found to have a mycotic thoracoabdominal aortic aneurysm (TAAA) extensively involving adjacent structures, including lungs with pleural cavity and upper renal pole. Not only does this case highlight the difficulty in early diagnosis and complex pathology of a mycotic TAAA, but it also illustrates the multidisciplinary approach required to effectively treat them.
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Affiliation(s)
- Maham Shahid
- Internal Medicine, HCA Florida Orange Park Hospital, Orange Park, USA
| | - Benjamin Phan
- Internal Medicine, HCA Florida Orange Park Hospital, Orange Park, USA
| | - Vincent Tir
- Internal Medicine, HCA Florida Orange Park Hospital, Orange Park, USA
| | - Corey Engel
- Radiology, University of Florida College of Medicine, Jacksonville, USA
| | - Jessica El-Bahri
- Internal Medicine, HCA Florida Orange Park Hospital, Orange Park, USA
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Erdem Ozdamar S, Koc AF, Durmus Tekce H, Kotan D, Ekmekci AH, Sengun IS, Yuceyar AN, Uluc K. Expert opinion on the diagnostic odyssey and management of late-onset Pompe disease: a neurologist's perspective. Front Neurol 2023; 14:1095134. [PMID: 37265469 PMCID: PMC10229878 DOI: 10.3389/fneur.2023.1095134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 04/14/2023] [Indexed: 06/03/2023] Open
Abstract
This consensus statement by a panel of neurology experts aimed to provide a practical and implementable guidance document to assist clinicians with the best clinical practice in terms of diagnosis, treatment, and monitoring of late-onset Pompe disease (LOPD). The participating experts consider the clinical suspicion of LOPD by the physician to be of utmost importance in the prevention of diagnostic and therapeutic delay in LOPD patients. A diagnostic algorithm is proposed to facilitate the diagnosis of LOPD in patients presenting with unexplained proximal/axial weakness (with or without respiratory symptoms) or restrictive respiratory insufficiency with hyperCKemia and/or exercise intolerance as the red flag symptoms/signs that raise the index of suspicion for LOPD diagnosis. The diagnosis is based on the subsequent use of dried blood spot (DBS) assay, and the DBS assay can be confirmed by acid alpha-glucosidase (GAA) tissue analysis in leukocytes, fibroblasts, or muscle fibers and/or genetic mutation analysis. Accordingly, experts consider increased awareness among physicians about potential presenting characteristics with a high index of suspicion for LOPD to be crucial to suspect and consider LOPD in the differential diagnosis, while strongly suggesting the use of a diagnostic algorithm combined with DBS assay and confirmatory tests in the timely diagnosis of LOPD and implementation of best practice patterns.
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Affiliation(s)
- Sevim Erdem Ozdamar
- Department of Neurology, Hacettepe University Faculty of Medicine, Ankara, Türkiye
| | - Ayse Filiz Koc
- Department of Neurology, Cukurova University Faculty of Medicine, Adana, Türkiye
| | - Hacer Durmus Tekce
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Türkiye
| | - Dilcan Kotan
- Department of Neurology, Sakarya University Faculty of Medicine, Sakarya, Türkiye
| | - Ahmet Hakan Ekmekci
- Department of Neurology, Selcuk University Faculty of Medicine, Konya, Türkiye
| | - Ihsan Sukru Sengun
- Department of Neurology, Dokuz Eylul University Faculty of Medicine, Izmir, Türkiye
| | - Ayse Nur Yuceyar
- Department of Neurology, Ege University Faculty of Medicine, Izmir, Türkiye
| | - Kayihan Uluc
- Department of Neurology, Marmara University School of Medicine, Istanbul, Türkiye
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